Cancers | 2021
Classifying Oligometastatic Non-Small Cell Lung Cancer
Abstract
Simple Summary Around half of patients with non-small cell lung cancer (NSCLC) have metastatic disease at the time of diagnosis. Some patients will have a limited number of metastatic sites, termed oligometastasis, rather than widespread disease. Aggressive treatment of oligometastasis has been supported by improved survival rates in retrospective studies, meta-analyses, and randomized phase II trials. Patient selection for aggressive local treatment of oligometastatic NSCLC would be facilitated by a common definition of what constitutes oligometastasis. We review the definitions of oligometastatic NSCLC proposed by consensus statements and those used in current treatment guidelines and previous trials of local consolidative therapy. Abstract An oligometastatic cancer state was first postulated in the 1990s by Hellman and Weichselbaum and described limited metastatic spread to a single or few sites of disease. It was hypothesized that this metastatic entity falls along a continuum of the natural history of cancer progression from a localized primary tumor to widespread metastases. Support for oligometastatic non-small cell lung cancer (NSCLC) has since been provided by multiple retrospective studies and then prospective randomized trials demonstrating better survival in this patient population after aggressive consolidative treatment. However, the lack of a universal definition of oligometastatic NSCLC has hindered a comparison between different studies and prevented well-defined recommendations for local consolidative treatment in this patient population. Attempts have been made to establish a common definition for use in clinical management and for the identification of inclusion criteria for future trials. In this review, we seek to summarize the current definitions of oligometastatic NSCLC based on recent expert consensus statements, previous randomized trials, and current treatment guidelines and to highlight the continued variability in current practice.