Elsevier

Journal of Thoracic Oncology

Volume 14, Issue 12, December 2019, Pages 2109-2119
Journal of Thoracic Oncology

Original Article
Non–Small Cell Lung Cancer
Definition of Synchronous Oligometastatic Non–Small Cell Lung Cancer—A Consensus Report

https://doi.org/10.1016/j.jtho.2019.07.025Get rights and content
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Abstract

Introduction

Improved outcome has been shown in patients with synchronous oligometastatic (sOM) NSCLC when treated with radical intent. As a uniform definition of sOM NSCLC is lacking, we developed a definition and diagnostic criteria by a consensus process.

Methods

A pan-European multidisciplinary consensus group was established. Consensus questions were built on the basis of current controversies, and definitions were extracted from a survey, cases and a systematic review. This statement was formulated during a consensus meeting.

Results

It was determined that definition of sOM NSCLC is relevant when a radical treatment that may modify the disease course (leading to long-term disease control) is technically feasible for all tumor sites with acceptable toxicity. On the basis of the review, a maximum of five metastases and three organs was proposed. Mediastinal lymph node involvement was not counted as a metastatic site. Fludeoxyglucose F 18 positron emission tomography–computed tomography and brain imaging were considered mandatory. A dedicated liver magnetic resonance imaging scan was advised for a solitary liver metastasis, and thoracoscopy and biopsies of distant ipsilateral pleural sites were recommended for a solitary pleural metastasis. For mediastinal staging, fludeoxyglucose F 18 positron emission tomography–computed tomography was deemed the minimum requirement, with pathological confirmation recommended if this influences the treatment strategy. Biopsy of a solitary metastatic location was mandated unless the multidisciplinary team is of the opinion that the risks outweigh the benefits.

Conclusion

A multidisciplinary consensus statement on the definition and staging of sOM NSCLC has been formulated. This statement will help to standardize inclusion criteria in future clinical trials.

Keywords

Non–small cell lung cancer
Oligometastatic disease
Consensus definition
Staging

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Disclosure: Dr. Dingemans has received honoraria for serving on advisory board for BMS, MSD, Roche, Eli Lilly, Takeda, Pfizer, Boehringer Ingelheim (all to her institution) and has received a research grant from BMS (to her institution) outside the submitted work. Dr. Hendriks has received research funding from Roche and Boehringer Ingelheim (both to her institution); received honoraria for serving on advisory boards for Boehringer Ingelheim (to her institution) and BMS (to both her institution and herself); received travel reimbursement from Roche and BMS; participated in a mentorship program with key opinion leaders that was funded by AstraZeneca; and received personal fees for educational webinars from Quadia. Dr. Faivre-Finn has received research funds from AstraZeneca and Electra. Dr. Greillier has received grants, personal fees, and nonfinancial support from Roche, Novartis, AstraZeneca, Pfizer, Bristol-Myers Squibb, and MSD, as well as personal fees and nonfinancial support from Boehringer Ingelheim and AbbVie outside the submitted work. Dr. O’Brien has performed advisory work for the pharmaceutical companies Roche, BMS, Boehringer Ingelheim, MSD, Pierre Fabre, and AbbVie. Dr. Reck has received personal fees from AbbVie, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Lilly, Merck, MSD, Novartis, Pfizer, and Roche outside the submitted work. Dr. Lievens has received personal fees from AstraZeneca and RayStation outside the submitted work. Dr. Guckenberger has received grants and personal fees from AstraZeneca; grants from Boehringer Ingelheim and Elpen; grants from Novartis; and personal fees from BMS, MSD, and Chiesi outside the submitted work. Dr. Peled has received honoraria for serving as an advisor to AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, FoundationMedicine, Gaurdant360, MSD, Novartis, NovellusDx, Pfizer, Roche, and Takeda. Dr. Novello has received personal fees from AbbVie, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, MSD, Takeda, Roche, and Pfizer outside the submitted work. Dr. Scagliotti has received personal fees from Eli Lilly, AstraZeneca, Roche, Pfizer, and MSD outside the submitted work. Dr. Senan has received departmental research grants from ViewRay, Inc., Varian Medical Systems, and AstraZeneca and has received honoraria for serving on advisory boards for AstraZeneca, Celgene, Merck, and Eli Lilly. Dr. Paz-Ares has received personal fees from Roche, Lilly, MSD, BMS, Novartis, Pfizer, AstraZeneca, Boehringer Ingelheim, Amgem, Sanofi, Pharmamar, Merck, and Takeda outside the submitted work. Dr. Cufer reports consultant fees and honoraria from AstraZeneca, BMS, Boehringer Ingelheim, MSD, Pfizer, and Roche outside the submitted work. Dr. Infante reports personal fees from MSD and Astra Zeneca outside the submitted work. Dziadziuszko reports personal fees from AstraZeneca, BMS, Boehringer Ingelheim, MSD, and Pfizer and personal fees and reimbursement for travel expenses from Roche outside the submitted work. Dr. Peters reports rreceiving honoraria or consultation fees from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis, Eli Lilly, F. Hoffmann-La Roche, Illumina, Janssen, Merck Sharp and Dohme, Merck Serono, Novartis, Pfizer, Regeneron, Seattle Genetics, and Takeda; receiving honoraria for giving a talk at public events organized by AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, F. Hoffmann-La Roche, Merck Sharp and Dohme, Novartis, and Pfizer; and receiving grants or research support as a (sub)investigator in trials sponsored by Amgen, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Clovis, F. Hoffmann-La Roche, Illumina, Merck Sharp and Dohme, Merck Serono, Novartis, and Pfizer outside the submitted work. De. de Ruysscher reports receiving honoraria for serving on advisory boards of Bristol-Myers-Squibb, AstraZeneca, Roche/Genentech, Merck/Pfizer, and Celgene and receiving research grants from Bristol-Myers Squibb and Boehringer Ingelheim (all to his institution) outside the submitted work. Dr. Besse has received institutional grants for clinical and translational research from AbbVie, Amgen, AstraZeneca, Biogen, Blueprint Medicines, BMS, Celgene, Eli Lilly, GSK, Ignyta, IPSEN, Merck KGaA, MSD, Nektar, Onxeo, Pfizer, Pharma Mar, Sanofi, Spectrum Pharmaceuticals, Takeda, and Tiziana Pharma outside the submitted work. The remaining authors declare no conflict of interest.