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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2019; 10(10): 318-339
Published online Oct 24, 2019. doi: 10.5306/wjco.v10.i10.318
Management of oligometastatic non-small cell lung cancer patients: Current controversies and future directions
Felipe Couñago, Javier Luna, Luis Leonardo Guerrero, Blanca Vaquero, María Cecilia Guillén-Sacoto, Teresa González-Merino, Begoña Taboada, Verónica Díaz, Belén Rubio-Viqueira, Ana Aurora Díaz-Gavela, Francisco José Marcos, Elia del Cerro
Felipe Couñago, Ana Aurora Díaz-Gavela, Francisco José Marcos, Elia del Cerro, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
Felipe Couñago, Luis Leonardo Guerrero, Blanca Vaquero, Ana Aurora Díaz-Gavela, Francisco José Marcos, Elia del Cerro, Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
Felipe Couñago, Ana Aurora Díaz-Gavela, Francisco José Marcos, Elia del Cerro, Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28223, Spain
Javier Luna, Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
María Cecilia Guillén-Sacoto, Teresa González-Merino, Department of Medical Oncology, Hospital La Luz, Madrid 28003, Spain
Begoña Taboada, Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
Verónica Díaz, Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Cádiz 11009, Spain
Belén Rubio-Viqueira, Department of Medical Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid 28223, Spain
Author contributions: All the authors contributed equally to this work.
Conflict-of-interest statement: The authors declare having no conflicts of interests related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Felipe Couñago, MD, PhD, Doctor, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Calle Diego de Velázquez 1, Pozuelo de Alarcón, Madrid 28223, Spain. fcounago@gmail.com
Telephone: +34-676-839746
Received: March 19, 2019
Peer-review started: March 19, 2019
First decision: August 2, 2019
Revised: August 30, 2019
Accepted: September 13, 2019
Article in press: September 13, 2019
Published online: October 24, 2019
Processing time: 220 Days and 12.1 Hours
Abstract

Oligometastatic non-small cell lung cancer (NSCLC) describes an intermediate stage of NSCLC between localized and widely-disseminated disease. This stage of NSCLC is characterized by a limited number of metastases and a more indolent tumor biology. Currently, the management of oligometastatic NSCLC involves radical treatment (radiotherapy or surgery) that targets the metastatic lesions and the primary tumor to achieve disease control. This approach offers the potential to achieve prolonged survival in patients who, in the past, would have only received palliative measures. The optimal therapeutic strategies for the different scenarios of oligometastatic disease (intracranial vs extracranial disease, synchronous vs metachronous) remain undefined. Given the lack of head-to-head studies comparing radiotherapy to surgery in these patients, the decision to apply surgery or radiotherapy (with or without systemic treatment) must be based on prognostic factors that allow us to classify patients. This classification will allow us to select the most appropriate therapeutic strategy on an individualized basis. In the future, the molecular or microRNA profiles will likely improve the treatment selection process. The objective of the present article is to review the most relevant scientific evidence on the management of patients with oligometastatic NSCLC, focusing on the role of radiotherapy and surgery. We also discuss areas of controversy and future directions.

Keywords: Non-small cell lung cancer; Metastasectomy; Oligometastases; Stereotactic ablative radiotherapy; Stereotactic body radiation therapy; Radiosurgery

Core tip: In recent years, numerous studies, including two randomized phase II trials, have demonstrated that local treatment, either radiotherapy or surgery, of the primary tumor and metastases improves progression-free survival and overall survival in patients who present with oligometastatic non-small cell lung cancer at diagnosis and in those who respond to the initial systemic therapy. As we await the results of ongoing randomized phase III trials, the main international clinical guidelines recommend a multimodal strategy to manage this subgroup of oligometastatic patients. Current guidelines recommend systemic therapy combined with local treatment of the metastases and, if applicable, the primary tumor.