title: Role of Local Ablative Therapy in Patients with Oligometastatic and Oligoprogressive Non-Small Cell Lung Cancer.
abstract: Because of an improved understanding of lung cancer biology and improvement in systemic treatment, an oligometastatic state in which metastatic disease is present at a limited number of anatomic sites is being increasingly recognized. An oligoprogressive state, which is a similar but distinct entity, refers to disease progression at a limited number of anatomic sites, with continued response or stable disease at other sites of disease. Such an oligoprogressive state is best described in patients with NSCLC treated with molecular targeted therapy. Possible explanations for development of the oligoprogressive state include the presence of underlying clonal heterogeneity and extrinsic selection pressure due to the use of targeted therapy. Traditionally, local ablative therapy (LAT) has been limited to symptom palliation in patients with advanced NSCLC, but the presence of oligometastatic or oligoprogressive disease provides a unique opportunity to evaluate the role of LAT such as surgery, radiation therapy, radiofrequency ablation, or cryoablation. There is increasing evidence to support the clinical benefit of LAT in patients with NSCLC with limited metastatic disease and in selected individuals in whom resistance to targeted therapies develops. In the latter instance, adequate treatment of drug-resistant clones by LAT could potentially help in avoiding switching systemic therapy prematurely. This review focuses on the biology of oligometastatic and oligoprogressive NSCLC and describes the role of LAT in the treatment of these conditions.
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Chul
authors: C
authors: Kim
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Chuong D
authors: CD
authors: Hoang
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Aparna H
authors: AH
authors: Kesarwala
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: David S
authors: DS
authors: Schrump
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors: Udayan
authors: U
authors: Guha
authors: Thoracic and Gastrointestinal Oncology Branch and Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: rajana@mail.nih.gov.
authors: Arun
authors: A
authors: Rajan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation; D018450:Disease Progression; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery
keywords: Local ablative therapy; Molecular targeted therapy; NSCLC; Oligometastatic disease; Oligoprogressive disease