Abstract
Simple SummaryApproximately 7–50% of patients with non-small-cell lung cancer (NSCLC) develop oligometastases, which are new tumors found in another part of the body, arising from cancer cells of the original tumor that have travelled through the body. In recent years, these patients have been increasingly regarded as a distinct group that could benefit from treatment that intends to cure the disease, rather than palliative care, to achieve a better clinical outcome. Various treatment procedures have been developed for treating NSCLC patients with different oligometastatic sites. In addition, the newly proposed uniform definition for oligometastases as well as ongoing trials may lead to increased appropriate patient selection and evaluation of treatment effectiveness. The aim of this review article is to summarize the latest evidence regarding optimal management strategies for NSCLC patients with oligometastases.Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC has been proposed, and this may facilitate trial design and evaluation of certain interventions. Patients with oligometastatic NSCLC are candidates for curative-intent management, in which local ablative treatment, such as surgery or stereotactic radiosurgery, should be instituted to improve clinical outcomes. Although current guidelines recommend that local therapy for thoracic and metastatic lesions should be considered for patients with oligometastatic NSCLC with stable disease after systemic therapy, optimal management strategies for different oligometastatic sites have not been established. Additionally, the development of personalized therapies for individual patients with oligometastatic NSCLC to improve their quality of life and overall survival should also be addressed. Here, we review relevant articles on the management of patients with oligometastatic NSCLC and categorize the disease according to the site of metastases. Ongoing trials are also summarized to determine future directions and expectations for new treatment modalities to improve patient management.
Highlights
Lung cancer is one of the most common cancer types worldwide [1–4], and nonsmall-cell lung cancer (NSCLC) is the most frequently diagnosed subtype [1,3,5–7]
The prognosis of patients with oligometastatic NSCLC is not as poor as traditionally believed, and the disease can be treated with curative-intent management to improve progression-free survival (PFS) and overall survival (OS)
Surgery or stereotactic radiosurgery can be applied as local ablative therapy and should be instituted for patients with oligometastatic NSCLC exhibiting stable disease after systemic treatment rather than maintenance therapy or observation alone
Summary
Lung cancer is one of the most common cancer types worldwide [1–4], and nonsmall-cell lung cancer (NSCLC) is the most frequently diagnosed subtype [1,3,5–7]. Continuing clinical trials have aimed to develop new drugs, including targeted therapies and immunotherapies, and these approaches have been broadly applied to improve the management of advanced NSCLC Modern imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have enabled accurate evaluation of the location and extent of metastatic disease. A consensus report on the definition of synchronous oligometastatic NSCLC was proposed [33]; in this report, the authors defined synchronous oligometastases as having no more than five metastases and three involved organs, and mediastinal lymph nodes were not considered metastatic sites. They reported that PET and brain MRI were required for staging. We discuss recent advancements in the management of patients with oligometastatic NSCLC and the categorization of oligometastatic NSCLC according to the site of metastases
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