A new clinical guideline from the American Society for Radiation Oncology (ASTRO) and European Society for Radiotherapy & Oncology (ESTRO) provides guidance on the use of definitive local therapy—including radiation and surgery—to treat patients with oligometastatic non-small cell lung cancer (NSCLC).
The guideline is published in Practical Radiation Oncology.
The guideline emphasises the need for a multidisciplinary team approach to guide treatment decisions for oligometastatic disease, a description for cancer that reaches a state in which the patient has a small number of metastases in addition to a primary tumour.
Treatment for oligometastatic NSCLC historically involved systemic therapy such as chemotherapy or immunotherapy, with local therapy given only for palliation and symptom relief.
A growing body of research, however, points to an additional role for definitive local therapy to all disease sites, aiming at durable tumour control and improved survival outcomes.
“Oligometastatic NSCLC is a phase in lung cancer development that may offer us new opportunities to improve patient outcomes, because it typically is more treatable than widely metastatic cancer,” said Puneeth Iyengar, MD, PhD, co-chair of the guideline task force and an associate professor of radiation oncology at UT Southwestern Medical Center in Dallas.
“The research on local therapy for oligometastatic cancer is still at a relatively early stage, but we already see indicators of potential benefits for patients. Adding local therapy to systemic therapy may lead to more durable cancer control, potentially improving progression-free survival, overall survival and quality of life.”
“Despite the widespread enthusiasm in the field of oligometastatic disease, the quality of evidence supporting the integration of definitive local therapy into a multimodality treatment strategy is still lower as compared to indications such as locally advanced NSCLC. To compensate for this lack of highest-quality evidence, recommendations of this guideline were established by a broad consensus involving experts from ASTRO and ESTRO, colleagues from the fields of thoracic surgery and medical oncology and a patient representative,” said Matthias Guckenberger, MD, co-chair of the guideline task force and a professor and chairperson of radiation oncology at the University Hospital Zurich in Switzerland.
The guideline addresses patient selection, treatment planning and delivery techniques for definitive local therapy to manage oligometastatic NSCLC, emphasising the need for patient-centered, multidisciplinary decision-making.
The guideline task force also created algorithms on the optimal clinical scenarios for local therapy and the different types of local therapy available for these patients.
Key recommendations are as follows:
Intracranial metastases were not included in this guideline, given the additional complexity involved in local therapy decisions for intracranial tumors.
ASTRO’s 2022 guideline for brain metastases provides guidance for these treatments, however.
The task force also emphasised the need for equitable use of these techniques, noting that “a significant effort must be taken to ensure that the decisions regarding the use of local therapies for oligometastatic NSCLC be applied equally across all patients to avoid any health disparities.”
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