Defining oligometastatic non-small cell lung cancer: A simulated multidisciplinary expert opinion

Hendriks, Lizza; Dooms, Christophe; Berghmans, Thierry; Novello, Silvia; Lévy, Antonin; Ruysscher, Dirk De; Hasan, Baktiar; Levra, Matteo Giaj; Levra, Niccolò Giaj; Besse, Benjamin; Vansteenkiste, Johan; Dingemans, Anne‐Marie C.

doi:10.1016/j.ejca.2019.09.013

Cited by 20 publications

(17 citation statements)

References 34 publications

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“…Whom is regarded as an oligometastatic patient and which treatments are offered tends to differ from physician to physician and has shifted over time, with a tendency to reserve radical local therapy such as SBRT for patients not progressing after systemic therapy (75). Furthermore, as compared to the theoretical definition of oligometastatic disease based on number of lesions, in the real-life setting, physicians tend to be more restrictive as to who they label as oligometastatic (75). Multiple studies have evaluated and suggested clinical prognostic markers to guide patient selection (19,(76)(77)(78)(79), however, these are all based on retrospective data, and have not yet been prospectively validated.…”

Section: Outcome Per Location: An Intricate Interplay Of Dose Volume and Primary Tumormentioning

confidence: 99%

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

Sundahl

Lievens

2021

Transl Lung Cancer Res

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Preclinical and early clinical evidence suggest that radical radiotherapy of oligometastatic disease in non-small cell lung cancer (NSCLC) patients can impact outcomes with relatively limited toxicity. Whilst data from phase 2 randomized trials suggesting an improved overall survival (OS) with this treatment is promising, it has also illustrated the heterogeneity in this patient population and treatment.Oligometastatic disease in itself comprises a broad spectrum of patients, in terms of tumor load and location, stage of the disease and treatment history. This real-life variety in patient characteristics is often reflected in studies to a certain extent, hinting to the fact that all might benefit from radical radiotherapy to limited metastatic disease, yet leaving the question unanswered as to whom the ideal candidate is. Furthermore, differences between and within studies with regards to treatment modality, timing, radiation technique, and radiation dose are substantial. Also, preclinical and early clinical trials suggest that radiotherapy can work synergistically with checkpoint inhibitors by acting as an in situ cancer vaccine, therefore the combination of these two treatments in oligometastatic patients might entail the largest benefit. Ongoing randomized controlled phase 3 trials and prospective registry trials will further elucidate the true extent of benefit of this local treatment strategy and aid in identifying the ideal patient population and therapy. The current narrative review summarizes the clinical evidence on radiotherapy for oligometastatic NSCLC and highlights the remaining unknowns.

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Section: Outcome Per Location: An Intricate Interplay Of Dose Volume and Primary Tumormentioning

confidence: 99%

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

Sundahl

Lievens

2021

Transl Lung Cancer Res

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“…These physicians considered patients to have oligometastatic disease if they had a single metastasis with or without lymph node involvement (N0-1). This practice excludes patients who might otherwise benefit from aggressive local therapy (18).…”

Section: Defining Oligometastasesmentioning

confidence: 99%

Oligometastatic non-small cell lung cancer: a narrative review of stereotactic ablative radiotherapy

Dohopolski¹,

Iyengar²

2021

Ann Palliat Med

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Non-small cell lung cancer (NSCLC) is the most common and deadly malignancy in the United States. A significant portion of these individuals can present with or later develop metastatic NSCLC (mNSCLC). These patients typically do not survive more than two to three years after diagnosis despite the use of systemic therapies; however, there are individuals with low burden mNSCLC (oligometastatic disease) who can potentially be cured with the use of aggressive local therapies-such as stereotactic ablative radiotherapy (SAbR)-in conjunction with or without systemic therapy. Oligometastatic disease represents an intermediate state prior to the development of widespread metastases. SAbR has been shown to be an effective modality for treating patients with oligometastatic NSCLC. The combination of immunotherapy and SAbR likely represents one of the most effective while still tolerable therapies in this patient population.There are other subtypes of oligometastatic disease, including oligoprogressive disease which are amenable to SAbR. The current literature supports the use of SAbR in this population to increase the time of a patient's current systemic therapy; however, there are prospective studies evaluating the efficacy of treatment on progression free survival (PFS).

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“…Recently, the EORTC-LCG published a consensus about the maximal number of metastases allowed to define sOM-NSCLC. Authors evaluated sOM-NSCLC definitions in daily clinical practice in Europe, by a survey and discussion of ten real life cases [7,8]. In the survey, the maximum number of metastases considered as sOM-NSCLC was again variable and 42 % of responders identified 3 as the correct definition [7].…”

Section: Tablementioning

confidence: 99%

Oligometastatic non-small cell lung cancer (NSCLC): Does number of metastasis matter?

et al. 2020

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Oligometastatic non-small cell lung cancer (NSCLC): Does number of metastasis matter? Synchronous oligometastatic (sOM) status is perceived as a distinct disease from polymetastatic presentation, with a potential higher overall survival (OS) probability when treated with local radical treatment (LRT). Recently, the long-term outcomes of the practice changing phase II randomized trial on sOM non-small cell lung cancer (NSCLC) were published [1]. Forty-nine patients with up to 3 metastases (primary tumor excluded) after first line systemic therapy were randomized to either LRT (i.e. radiotherapy or surgery) to all disease sites or 37 5 N.A. 65% 35% *56 % with single metastasis, 44 % ≥ 2 metastases; ** 14 patients received a LCT (randomized trial); N.A.: not available.

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Defining oligometastatic non-small cell lung cancer: A simulated multidisciplinary expert opinion

Cited by 20 publications

References 34 publications

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

Radiotherapy for oligometastatic non-small cell lung cancer: a narrative review

Oligometastatic non-small cell lung cancer: a narrative review of stereotactic ablative radiotherapy

Oligometastatic non-small cell lung cancer (NSCLC): Does number of metastasis matter?

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