Oligometastases

Abstract

At present, non-small lung cancer (NSCLC) patients are divided into patients without (stage I-III) and with distant metastases (stage IV) at diagnosis. The former group is treated with radical intent, the latter group with palliative systemic treatment. In recent years however, it has become clear that there is a subgroup of stage IV patients with only a few metastases at diagnosis (called “oligometastases”) that may survive longer. This oligometastatic phenotype is nowadays more common because of the widespread use of FDG-PET-CT as standard staging procedure. With technological advances it is now feasible to treat multiple tumor sites with radical intent with less invasive treatment procedures such as stereotactic ablative radiotherapy, video-assisted thoracic surgery or radiofrequency ablation. A favourable outcome has repeatitively been observed with a progression-free survival (PFS) of 14% and overall survival (OS) of 17% at 3 years, whereas OS is around 0-5% in stage IV NSCLC patients treated with palliative systemic chemotherapy only. The question remains how to detect this favourable subgroup for radical treatment before the start of any treatment, to avoid unnecessary treatments with their potential morbidities.