Radical Treatment of Non–Small-Cell Lung Cancer Patients with Synchronous Oligometastases: Long-Term Results of a Prospective Phase II Trial (Nct01282450)

Ruysscher, Dirk De; Wanders, Rinus; Baardwijk, Angela van; Dingemans, Anne‐Marie C.; Reymen, Bart; Houben, Ruud; Bootsma, Gerben; Pitz, Cordula; Eijsden, Linda van; Geraedts, Wiel; Baumert, Brigitta G.; Lambin, Philippe

doi:10.1097/jto.0b013e318262caf6

Cited by 250 publications

(216 citation statements)

References 43 publications

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“…For patients with NSCLC stage IV, if we select complete resection of the primary lesion as the initial treatment, an important consideration is whether local therapy, such as surgical resection or radiotherapy, is possible for the metastasis. These issues have been considered in both prospective and retrospective studies on oligometastasis (4,(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have analyzed oligometastatic disease (4,(6)(7)(8)(9)(10) and pleural dissemination in stage IV NSCLC (2,3). However, there are few reports that deal only with stage IV NSCLC.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of extrathoracic metastasis, Hellman and Weichselbaum proposed a clinically recognizable state termed oligometastasis, which is characterized by a limited number of metastatic tumors in a limited number of sites (6). Local therapies such as surgery or radiotherapy, given alone or combination with systemic therapy, may allow curative treatment of oligometastasis (4,7,8). In synchronous oligometastatic patients, local therapy may significantly prolong the overall survival time (4,(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

et al. 2017

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Background:The standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) is systemic chemotherapy. However, certain patients, such as those with oligometastasis or M1a disease undergo resection of the primary lesion. Results: The median follow-up duration for the 38 patients (27 men) was 17.7 months (range, 1-82.3 months). The T factors were T1/T2/T3/T4 in 4/16/12/6 patients, respectively. The N factors were N0/N1/N2/N3 in 16/8/12/2 patients, respectively. The M factors were M1a/M1b/M1c in 19/13/6 patients, respectively. Of the 19 M1a patients, 11 were classified as cM0. We introduced the novel classification M-better/M-worse. M-better includes cM0 patients and M1b and M1c patients in whom all lesions have been locally controlled. M-worse includes cM1a patients and M1b and M1c patients in whom lesions cannot be locally controlled. The new M-better/M-worse statuses were 24/14 patients, respectively. The histology of NSCLC was adenocarcinoma/squamous cell carcinoma/others in 30/5/3 patients, respectively. The 5-year overall survival rate was 29%, and the median survival time was 725 days. Squamous cell carcinoma and M-worse were significant factors predicting poor outcomes (P=0.0017, P=0.0007, respectively).Conclusions: Even for stage IV NSCLC patients, resection of the primary lesion may be beneficial, especially for those with M-better status and those not diagnosed with squamous-cell carcinoma (SCC).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

et al. 2017

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“…31,32 Patients with a single metastatic lesion at one organ site (brain, liver, bone, skin, adrenal gland) have similar prognoses as those patients with M1a disease. The new staging proposal divides distant metastases into 2 categories based on the prognostic difference between patients with a single metastatic lesion in a single organ (M1b) and patients with multiple metastatic lesions in multiple organs or in a single organ (M1c) ( Table 3).…”

Section: Categorymentioning

confidence: 99%

Lung Carcinoma Staging Update

Đačić

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The International Association for the Study of Lung Cancer Staging Committee has prospectively created an international lung cancer database that was used to address many lung cancer staging questions, such as tumor size, nodal status, and metastatic disease. The proposed changes for the upcoming 8th edition of the cancer staging manual were based on survival data and better prognostic stratification of patients with lung cancer. Objectives.— To review published recommendations for the revision of lung carcinoma TNM staging and to address potential challenges in pathologic staging. Data Source.— PubMed available articles by the International Association for the Study of Lung Cancer Staging Committee were reviewed. Conclusions.— The TNM system remains the best prognosticator of lung cancer outcome. The recommendations are established on new prospective data analysis and reflect the improvements in prognostic separation of patients with lung cancer based on a multidisciplinary approach.

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“…For many years, surgeons have offered curative resections to patients presenting with a solitary synchronous brain or adrenal metastasis [156,157]. Resection of the metastatic lesion is offered when the primary site is controlled.…”

Section: Surgery For Stage IV Lung Cancer (Solitary Metastasis)mentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Radical Treatment of Non–Small-Cell Lung Cancer Patients with Synchronous Oligometastases: Long-Term Results of a Prospective Phase II Trial (Nct01282450)

Abstract: In this phase II study, long-term PFS was found in a subgroup of NSCLC patients with synchronous oligometastases when treated radically. Identification of this favorable subgroup before therapy is needed.

Cited by 250 publications

References 43 publications

Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

Complete resection of the primary lesion improves survival of certain patients with stage IV non-small cell lung cancer

Lung Carcinoma Staging Update

Surgery for nonsmall cell lung cancer

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