NSCLC: European consensus report defines oligometastatic disease

  • Dingemans AC & al.
  • J Thorac Oncol
  • 6 Aug 2019

  • Oncology guidelines update
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Takeaway

  • Thoracic oncology experts convened by the European Organization of Research and Treatment of Cancer Lung Cancer Group have developed the first consensus statement on the definition and staging of synchronous oligometastatic (sOM) NSCLC, which could aid in diagnosis, treatment, and clinical research.

Why this matters

  • Past clinical trials led to the inclusion of sOM NSCLC as a special treatment entity in the 2016 and 2018 European Society of Medical Oncology (ESMO) guidelines and in the National Comprehensive Cancer Network (NCCN) guideline, but employed different definitions and staging procedures for the disease.

Key elements

  • Definition of sOM NSCLC includes a maximum of 5 metastases and 3 organs; mediastinal lymph node involvement is not considered a metastatic site.
  • Staging requires 18fluorodeoxyglucose-positron emission tomography (18F-FDG-PET-CT) and brain imaging.
  • For staging, patients with a solitary liver metastasis should undergo dedicated liver MRI. Those with a solitary pleural metastasis should undergo thoracoscopy and biopsies of distant ipsilateral pleural sites.
  • 18F-FDG-PET-CT is the minimum requirement for mediastinal staging, with pathological confirmation if the results affect treatment strategy.
  • Solitary metastatic locations should be biopsied unless the multidisciplinary team determines the risks outweigh the benefits.

Limitations

  • Lack of clinical evidence.
  • All-European expert panel.