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Paul De Leyn
IBS23 - Treatment of NSCLC OMD in Clinical Practice (Ticketed Session) (ID 54)
- Event: WCLC 2019
- Type: Interactive Breakfast Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Coordinates: 9/10/2019, 07:00 - 08:00, Toronto (1985)
IBS23.03 - Surgical Treatment of OMD in Daily Clinical Practice (Now Available) (ID 3387)
07:00 - 08:00 | Presenting Author(s): Paul De Leyn
Patients with metastatic non-small cell lung cancer (stage IV) are usually deemed to be incurable and no local aggressive treatment is generally indicated. However, stage IV NSCLC cancer is a heterogeneous group. This is confirmed by the 8 thh TNM NSCLC staging system. Stage M1a are patients with separate tumor nodules (s) in a contralateral lobe, tumor metastatic pleural or pericardial nodule, or malignant pleural pericardial effusion. M1b is single extra thoracic metastatic disease in one organ and M1c are patients with multiple extra thoracic metastasis in one or several organs.
Oligometastatic disease is widely recognized as patients with a limited number of controllable secondary lesions. The exact number of metastasis and definition is still debate.
Over the last years remarkable advances in chemotherapy strategy and immunotherapy have resulted in substantial survival benefits in patients with stage IV NSCLC. This questions in some patients the need of aggressive treatment of residual or recurrent disease.
In literature, there are several studies on the role of surgery in patients with lung cancer and single metastasis in the brain, adrenal or contralateral lung. Most of the evidence is based on small retrospective series that were collected over an extended period of time.
More recently, there is some experience with multimodal treatment including surgery in patients with oligometastatic disease and more metastasis also in different organs. There are several prognostic factors. Mediastinal nodal involvement and tumor size are important. In all patients, FDG- PET could be performed. Since prognosis is very small in N2 patients, invasive mediastinal staging (endoscopically or surgically) should be performed before embarking on an aggressive multimodal surgical treatment of oligometastatic disease. Over the last years, robotic surgery or uniportal VATS is becoming less invasive with less postoperative complications and better tolerance of neoadjuvant or adjuvant therapy. When surgery is part of multimodal treatment of patients with oligometastatic disease pneumonectomy should be avoided.
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