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Klaus L. Irion



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    ES21 - Current Strategies to Improve Outcome of Patients with Oligometastatic NSCLC (ID 24)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Now Available
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      ES21.01 - Optimal Imaging for Staging of OMD (Now Available) (ID 3269)

      15:45 - 17:15  |  Presenting Author(s): Klaus L. Irion

      • Abstract
      • Presentation
      • Slides

      Abstract

      The role of imaging in oligometastatic disease in NSCLC:

      The current guidelines include a contrast-enhanced CT of the chest and upper abdomen as the baseline imaging investigation of lung cancer patients. A contrast-enhanced CT or MRI of the brain is indicated in patients who present with neurological signs/symptoms1. An additional investigation with PET-CT and MRI could be considered, "but only if their results could alter the treatment strategy"2. Lung cancer patients who are candidates to a radical treatment should be referred to a PET-CT if the initial investigations indicate a potentially curable disease2. Not infrequently, the identification of unsuspected metastasis on the PET-CT changes the initial staging to a stage IV, in a significant number of cases. A radical treatment can be considered for those with oligometastatic disease (OMD), which is defined by the National Cancer Institute as: "a small number of metastatic tumors in one or two other parts of the body"3. Discerning additional lung lesions as benign or malignant can be improved with the use of MRI4,5. Considering the limitations of PET-CT for detecting brain and liver metastases, MRI should be considered to avoid a futile extended radical treatment in this select group of patients5. This presentation will discuss the role of imaging in OMD patients being considered for extended radical treatment.

      1. NICE. https://www.nice.org.uk/guidance/ng122/chapter/Recommendations#diagnosis-and-staging

      2. Planchard D. et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology (2018) 29(4): iv192–iv237.

      3. NCI. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/oligometastasis.

      4. Basso Dias A. et al. Fluorine 18–FDG PET/CT and diffusion-weighted MRI for malignant versus benign pulmonary lesions: a meta-analysis. Radiology (2019) 290:525–534

      5. Hochhegger B. et al. MRI in lung cancer: a pictorial essay. BJR (2011) 84:1003, 661-668

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