The Objective of Local Therapy in Oligometastatic Cancer Is a Moving Target

To the Editor Over the past 3 decades, clinicians have selectively offered local therapy (surgery, radiation therapy, ablation) to patients with oligometastatic lung cancer in pursuit of 5-year survivorship. Although considered a "curative-intent" approach (recognizing that not all 5-year survivors are actually cured), it is unclear whether 5-year survivorship is enabled by this approach, or simply associated (ie, best-prognosis stage IV patients). Furthermore, the success of the curative-intent approach is predicated on identifying patients (1) whose disease is confined to the imaged oligometastases (no disease elsewhere) and (2) who can be rendered truly disease-free with local therapy. Currently, the presence of mediastinal lymph node metastases (ie, N2 disease) has functioned as the best marker for patient selection for the curative-intent approach because N2 disease has been associated with a prohibitively poor prognosis and is considered a contraindication.

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