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Current Management of Oligometastatic Lung Cancer and Future Perspectives

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 14738

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Special Issue Editor

Dr. Gaetano Rocco

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Guest Editor

Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
Interests: lung cancer; oligometastatic disease; local consolidative treatment

Special Issue Information

Dear Colleagues,

The role of local consolidative treatment (LCT) in the management of patients with oligometastatic IV lung cancer is undergoing serious discussion within multidisciplinary oncologic groups. In particular, in patients with less than five extra-thoracic metastases in less than three organs, LCT—inclusive of surgery for primary lung tumor, lymph nodes and/or metastases as indicated—has proven to be a significant contributing factor to improve progression-free survival in patients with oligometastatic disease after first-line chemotherapy, with or without maintenance treatment (Gomez, Lancet Oncol 2016). At least one more RCT (Iyengar JAMA Oncol 2018), as well as several surgical retrospective studies, have corroborated these findings (Opitz, EJTCS 2020; Mitchell, JTCVS 2020 and Clin Lung Cancer 2020). Furthermore, the recent evidence from the COMET (Palma, Lancet 2019) trial may have shed a new light on the role of SBRT. This Special Issue is aimed at presenting the previous evolution, the current indication and approaches, as well as future perspectives of LCT on the management of oligometastatic disease by involving the real experts in the field as authors.

Prof. Dr. Gaetano Rocco
Guest Editor

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Keywords

oligometastatic lung cancer
local consolidative treatment

Published Papers (6 papers)

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Research

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9 pages, 232 KiB

Open AccessArticle

The Role of Surgery for Oligometastatic Non-Small Cell Lung Cancer

by Caleb J. Euhus, Taylor R. Ripley and Cristian G. Medina

Cancers 2022, 14(10), 2524; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14102524 - 20 May 2022

Cited by 5 | Viewed by 1471

Abstract

Oligometastatic non-small cell lung cancer (NSCLC) is metastatic disease that refers to a limited number of metastatic sites. It is analogous to an intermediate stage of NSCLC, between localized and widely metastatic disease, even though no staging criteria establishes this distinction. Oligometastatic NSCLC describes a patient subgroup with limited metastasis to one or a few organs. These patients seem to have a more indolent cancer than those with diffuse metastasis. For these select patients with oligometastatic disease, the use of palliative systemic therapy over local aggressive treatment may be a missed opportunity to improve survival. The clear definition of this subgroup and identification of the best treatment remains the current challenge in the management of the disease. Surgery was the early cornerstone in the treatment of limited disease; however, as modalities such as chemotherapy, stereotactic radiosurgery, and immunotherapy have matured, the role of excision is less clearly defined. There are sparse randomized controlled trials comparing the efficacy of different treatment modalities in patients with oligometastatic NSCLC. However, there is a growing body of retrospective research detailing the prognostic factors that characterize the role of surgery in the management of these patients. This article clarifies the context and definition of the term oligometastatic, as it applies to NSCLC, and reviews the current results in the use of surgery for its management. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

Review

Jump to: Research

17 pages, 320 KiB

Open AccessReview

Local Consolidative Therapy for Oligometastatic Non-Small Cell Lung Cancer

by Patricia Mae G. Santos, Xingzhe Li and Daniel R. Gomez

Cancers 2022, 14(16), 3977; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14163977 - 17 Aug 2022

Cited by 3 | Viewed by 2063

Abstract

In the last 20 years, significant strides have been made in our understanding of the biological mechanisms driving disease pathogenesis in metastatic non-small cell lung cancer (NSCLC). Notably, the development and application of predictive biomarkers as well as refined treatment regimens in the form of chemoimmunotherapy and novel targeted agents have led to substantial improvements in survival. Parallel to these remarkable advancements in modern systemic therapy has been a growing recognition of “oligometastatic disease” as a distinct clinical entity—defined by the presence of a controlled primary tumor and ≤5 sites of metastatic disease amenable to local consolidative therapy (LAT), with surgery or stereotactic ablative body radiotherapy (SABR). To date, three randomized studies have provided clinical evidence supporting the use of LAT/SABR in the treatment of oligometastatic NSCLC. In this review, we summarize clinical evidence from these landmark studies and highlight ongoing trials evaluating the use of LAT/SABR in a variety of clinical contexts along the oligometastatic disease spectrum. We discuss important implications and caveats of the available data, including considerations surrounding patient selection and application in routine clinical practice. We conclude by offering potential avenues for further investigation in the oligometastatic disease space. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

13 pages, 1142 KiB

Open AccessReview

Patient Selection for Local Aggressive Treatment in Oligometastatic Non-Small Cell Lung Cancer

by Raphael S. Werner and Isabelle Opitz

Cancers 2021, 13(24), 6374; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246374 - 19 Dec 2021

Cited by 4 | Viewed by 3334

Abstract

One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons. A surgical resection of the often advanced primary tumor should be part of the radical treatment whenever feasible. However, patient selection, timing, and a correct treatment allocation for LAT appear to be essential. In this review, we aimed to summarize and discuss the current evidence on patient selection criteria such as characteristics of the primary tumor and metastases, response to neoadjuvant or first-line treatment, molecular characteristics, mediastinal lymph node involvement, and other factors for LAT in oligometastatic NSCLC. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

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13 pages, 259 KiB

Open AccessReview

Results of Radiation Therapy as Local Ablative Therapy for Oligometastatic Non-Small Cell Lung Cancer

by David L. Billing and Andreas Rimner

Cancers 2021, 13(22), 5773; https://doi.org/10.3390/cancers13225773 - 18 Nov 2021

Viewed by 1782

Abstract

Oligometastatic cancer is characterized by a limited number of metastatic deposits. Compared with lung cancer patients who have more widespread disease, oligometastatic lung cancer patients have more favorable survival outcomes. Therefore, it has been hypothesized that local ablative therapy (LAT) directed at the metastatic deposits in addition to standard-of-care systemic therapy may further improve survival outcomes in oligometastatic lung cancer patients. One LAT modality that has been utilized in oligometastatic lung cancer is radiation therapy. In particular, ultra-hypofractionated radiotherapy, also known as stereotactic body radiotherapy (SBRT), has been shown to provide excellent local control with a favorable safety profile. Here, we reviewed the retrospective studies and prospective trials that have deployed radiation therapy as LAT in oligometastatic lung cancer, including randomized studies showing benefits for progression-free survival and overall survival with the addition of LAT. We also discuss the impact of targeted therapies and immunotherapy on radiation as LAT. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

19 pages, 1006 KiB

Open AccessReview

Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy

by Mario Ghosn and Stephen B. Solomon

Cancers 2021, 13(20), 5202; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205202 - 16 Oct 2021

Cited by 19 | Viewed by 2780

Abstract

A growing body of evidence shows improved overall survival and progression-free survival after thermal ablation in non-small cell lung carcinoma (NSCLC) patients with a limited number of metastases, combined with chemotherapy or tyrosine kinase inhibitors or after local recurrence. Radiofrequency ablation and microwave ablation are the most evaluated modalities, and target tumor size <3 cm (and preferably <2 cm) is a key factor of technical success and efficacy. Although thermal ablation offers some advantages over surgery and radiotherapy in terms of repeatability, safety, and quality of life, optimal management of these patients requires a multidisciplinary approach, and further randomized controlled trials are required to help refine patient selection criteria. In this article, we present a comprehensive review of available thermal ablation modalities and recent results supporting their use in oligometastatic and oligoprogressive NSCLC disease along with their potential future implications in the emerging field of immunotherapy. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

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11 pages, 505 KiB

Open AccessReview

Classifying Oligometastatic Non-Small Cell Lung Cancer

by Alisa N. Blumenthaler and Mara B. Antonoff

Cancers 2021, 13(19), 4822; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13194822 - 27 Sep 2021

Cited by 7 | Viewed by 2626

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. Full article

(This article belongs to the Special Issue Current Management of Oligometastatic Lung Cancer and Future Perspectives)

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