The Slippery Slope of Broadening Treatment Eligibility and Weak End Points: Defending the Oligo in Oligometastatic Non–Small-Cell Lung Cancer

The concept of oligometastatic disease extends from that of the precocious metastasis, a clinical setting in which a patient has a focus of metastatic disease that may not be accompanied by widespread micrometastatic disease and therefore may potentially be cured with local therapy to both the primary cancer and an isolated metastatic focus.¹ Patients with a single brain or adrenal metastasis from non–small-cell lung cancer (NSCLC) may have a 5-year survival of 25% after resection of both the primary cancer and metastasis,² vastly exceeding the negligible long-term survival of more widespread metastatic NSCLC. Patients who have undergone resection for limited hepatic metastases from colon cancer³ or of lung metastases from sarcoma and colorectal cancer⁴ also may demonstrate very prolonged survival.