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Cancers
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The Current Status of Treatment for Oligometastatic Lung Cancer
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The Current Status of Treatment for Oligometastatic Lung Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 May 2025) | Viewed by 4963

Special Issue Editor

Dr. Yoshihisa Shimada

E-Mail Website
Guest Editor
Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
Interests: video-assisted thoracic surgery; minimally invasive surgery; artificial intelligence and lung cancer; cancer-derived exosomes

Special Issue Information

Dear Colleagues,

The emergence of effective systemic therapies, such as immune checkpoint inhibitors and molecular-targeted therapies, along with the advent of precision medicine, has improved survival outcomes in advanced non-small-cell lung cancer. However, only a fraction of cases can avoid recurrence or progression. In this context, there has been increased awareness of the disease state, known as "oligometastases", and a multidisciplinary treatment strategy combining systemic and local ablative therapies has been explored for certain patients, potentially aiming to develop a cure.

The primary local treatment for oligometastatic lung cancer is radiation therapy, with high-precision radiation therapy being central to local ablative therapy in several ongoing randomized phase III trials. Studies exclusively focused on surgical treatment for oligometastatic lung cancer have been limited, although there are situations where surgical treatment is prioritized for local lesions. It is essential to clarify the criteria for local ablative therapy and to classify oligometastatic states systematically to develop an effective oligometastatic lung cancer treatment strategy in the future.

Dr. Yoshihisa Shimada
Guest Editor

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Keywords

  • oligometastases
  • oligo-recurrence
  • lung cancer
  • local ablative therapy

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Published Papers (4 papers)

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Review

27 pages, 1013 KB  
Review
Efficacy of Radiotherapy for Oligometastatic Lung Cancer and Irradiation Methods Based on Metastatic Site
by Katsuyuki Shirai, Masashi Endo, Shuri Aoki, Noriko Kishi, Yukiko Fukuda, Tetsuo Nonaka and Hitoshi Ishikawa
Cancers 2025, 17(15), 2569; https://doi.org/10.3390/cancers17152569 - 4 Aug 2025
Viewed by 744
Abstract
Systemic chemotherapy is a standard treatment for patients with stage IV cancer with distant metastases, and there is little evidence of the effectiveness of local treatments for distant metastatic lesions. However, in recent years, randomized phase II trials targeting oligometastases in lung cancer [...] Read more.
Systemic chemotherapy is a standard treatment for patients with stage IV cancer with distant metastases, and there is little evidence of the effectiveness of local treatments for distant metastatic lesions. However, in recent years, randomized phase II trials targeting oligometastases in lung cancer and solid tumors have reported that local therapy combined with systemic chemotherapy improves clinical outcomes. We reviewed previous clinical trials and demonstrated the efficacy of radiotherapy for oligometastatic disease. Stereotactic body radiotherapy (SBRT) is a promising treatment that achieves high local control rates for oligometastatic disease. Although SBRT generally does not cause severe adverse events, the safety of SBRT combined with systemic chemotherapy needs to be carefully considered. We discussed the efficacy and safety of SBRT and summarized the details of SBRT methods and techniques for each metastatic site. Further research and clinical trials are warranted to improve the efficacy of SBRT combined with systemic chemotherapy for oligometastatic non-small cell lung cancer (NSCLC). Full article
(This article belongs to the Special Issue The Current Status of Treatment for Oligometastatic Lung Cancer)
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Figure 1

19 pages, 1798 KB  
Review
Current Status of Multimodal Therapy for Oligometastatic Disease, Induced Oligometastatic Disease, and Oligo-Progressive Disease in EGFR-Mutated Non-Small-Cell Lung Cancer
by Taichi Miyawaki, Hirotsugu Kenmotsu, Ryo Ko, Masaki Oshima, Takehito Shukuya, Naoto Shikama and Kazuhisa Takahashi
Cancers 2025, 17(13), 2202; https://doi.org/10.3390/cancers17132202 - 30 Jun 2025
Viewed by 756
Abstract
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have shown clinical activity for patients with EGFR-mutated non-small-cell lung cancer (NSCLC). However, the development of resistance to EGFR-TKIs is almost inevitable, posing a significant barrier to long-term survival. Local ablative therapy (LAT) may [...] Read more.
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have shown clinical activity for patients with EGFR-mutated non-small-cell lung cancer (NSCLC). However, the development of resistance to EGFR-TKIs is almost inevitable, posing a significant barrier to long-term survival. Local ablative therapy (LAT) may facilitate the prolonged survival of patients with oligometastatic NSCLC. Therapeutic combinations of EGFR-TKIs and LAT for residual disease have been suggested to be potentially effective in EGFR-mutated NSCLC with induced oligometastatic disease, wherein a few lesions remain following initial EGFR-TKI treatment. Various resistance pathways for third-generation EGFR-TKIs including osimertinib, current standard of care for patients with EGFR-mutated NSCLC, have also been identified. In addition to resistance mechanisms, the disease-progression pattern may be an essential element for achieving long-term response and survival. Oligo-progressive disease is a state in which only a few lesions become resistant, whereas many lesions remain controlled with effective systemic therapy. Previous studies have shown that LAT for all oligo-progressive lesions could provide survival benefits. This review discusses the current treatment options and potential future therapeutic developments for patients with EGFR-mutated NSCLC who have synchronous oligometastatic disease, oligo-residual disease during treatment with EGFR-TKIs, and oligo-progressive disease following resistance to EGFR-TKIs. Full article
(This article belongs to the Special Issue The Current Status of Treatment for Oligometastatic Lung Cancer)
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Graphical abstract

12 pages, 229 KB  
Review
Surgical Management of Oligometastatic Non-Small Cell Lung Cancer
by Susana Fortich, Deniz Piyadeoglu, Nafiye Busra Celik and Mara Antonoff
Cancers 2025, 17(12), 2040; https://doi.org/10.3390/cancers17122040 - 18 Jun 2025
Viewed by 1307
Abstract
Background: Oligometastatic non-small cell lung cancer (NSCLC) represents a biologically and clinically distinct state characterized by limited metastatic spread. Increasing evidence suggests that aggressive local therapies, including surgical resection, may confer a survival benefit in this population. The objective of this review is [...] Read more.
Background: Oligometastatic non-small cell lung cancer (NSCLC) represents a biologically and clinically distinct state characterized by limited metastatic spread. Increasing evidence suggests that aggressive local therapies, including surgical resection, may confer a survival benefit in this population. The objective of this review is to evaluate the current role of surgery in the management of oligometastatic NSCLC, with emphasis on patient selection, surgical strategy, integration with systemic therapy, and ongoing clinical investigations. Methods: This narrative review synthesizes retrospective and prospective clinical data, meta-analyses, major consensus guidelines, and ongoing trials since 2012. We highlight prognostic factors, staging strategies, and the evolving role of molecular and biomarker-based stratification. Results: Multiple retrospective studies and several randomized trials have demonstrated improved progression-free and overall survival with local consolidative therapy in oligometastatic NSCLC. Prognostic factors associated with favorable outcomes include a limited number of metastases (≤3), good performance status, absence of mediastinal nodal disease, metachronous presentation, and actionable molecular alterations. The integration of surgery with systemic therapies, including targeted agents and immunotherapy, has become increasingly common in selected patients. Ongoing trials such as LONESTAR, NORTHSTAR, and BRIGHTSTAR are expected to further define the role of surgery in this setting. Conclusions: Surgery is emerging as a key component of multimodal treatment for carefully selected patients with oligometastatic NSCLC. Future efforts should focus on refining patient selection through molecular stratification and expanding prospective trial data to guide personalized biology-driven treatment strategies. Full article
(This article belongs to the Special Issue The Current Status of Treatment for Oligometastatic Lung Cancer)
11 pages, 216 KB  
Review
Oligo-Recurrence in Lung Cancer; The Most Curable State Among Advanced Disease?
by Yoshihisa Shimada
Cancers 2024, 16(23), 4086; https://doi.org/10.3390/cancers16234086 - 6 Dec 2024
Cited by 2 | Viewed by 1567
Abstract
Despite the introduction of effective systemic therapies and advancements in precision medicine, recurrence or progression remains common in advanced non-small cell lung cancer (NSCLC). For a subset of patients with more localized metastatic disease—referred to as oligometastases and oligo-recurrence—emerging evidence suggests that a [...] Read more.
Despite the introduction of effective systemic therapies and advancements in precision medicine, recurrence or progression remains common in advanced non-small cell lung cancer (NSCLC). For a subset of patients with more localized metastatic disease—referred to as oligometastases and oligo-recurrence—emerging evidence suggests that a multimodal approach combining systemic therapy with local ablative therapies (LATs) may offer curative potential. Oligo-recurrence is defined by the presence of a limited number of metastases and recurrences in patients with controlled primary lesions. In this review, we focus on providing a comprehensive overview of the evidence supporting the concepts of oligo-recurrence in lung cancer, which is considered one of the most curable states among advanced diseases. Although the definition remains variable and is still under discussion, retrospective studies have reported that it is not a rare condition (occurring in 18–53% of cases) and shows relatively better survival outcomes regardless of whether a local ablative therapy (LAT) is performed. However, this classification remains a topic of ongoing debate and warrants further exploration. In addition to an ongoing randomized clinical trial on oligo-recurrent NSCLC, further rigorous studies specifically addressing oligo-recurrence are needed to refine treatment strategies for this advanced yet potentially curable state. These investigations are essential for developing effective, tailored approaches to optimize outcomes for patients within this prognostically favorable subgroup. Full article
(This article belongs to the Special Issue The Current Status of Treatment for Oligometastatic Lung Cancer)
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