Integration of definitive local therapy relevant if technically feasible and clinically safe to all disease sites
By Elana Gotkine HealthDay Reporter
TUESDAY, May 2, 2023 (HealthDay News) — A patient-centered, multidisciplinary approach is strongly recommended for decision-making regarding treatment for oligometastatic non-small cell lung cancer (NSCLC), according to a clinical practice guideline issued jointly by the American Society for Radiation Oncology and European Society for Radiotherapy and Oncology and published online April 25 in Practical Radiation Oncology.
Puneeth Iyengar, M.D., Ph.D., from UT Southwestern in Dallas, and colleagues addressed five key questions relating to use of local and systematic therapy in the management of oligometastatic NSCLC. Recommendations were based on a systematic literature review.
The authors note that a patient-centered, multidisciplinary approach is strongly recommended for all decision-making regarding potential treatment based on a lack of significant randomized phase 3 trials. Definitive local therapy integration is relevant if technically feasible and clinically safe to all disease sites (five or fewer). Definitive local therapies are conditionally recommended in synchronous, metachronous, oligopersistent, and oligoprogressive conditions for extracranial disease. The only primary definitive local therapy modalities recommended for use in management of oligometastatic disease are radiation and surgery; indications are provided for choosing one over the other. For systemic and local therapy integration, sequencing recommendations are provided. Recommendations are also provided for optimal technical use of hypofractionated radiation or stereotactic body radiation therapy as definitive local therapy.
“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,” a coauthor said in a statement. “To compensate for this lack of highest-quality evidence, recommendations of this guideline were established by a broad consensus.”
Several authors disclosed financial ties to the pharmaceutical industry.
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