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- / , - Lung malignant tumors are the most common non-skin cancer and the leading cause of cancer death. It accounts for ~ of lung cancer, and most of them are patients with advanced metastasis. In the past, the treatment of metastasis could only rely on palliative radiotherapy and chemotherapy.
- / , -New drugs, better supportive care and advanced imaging, surgery and technology have greatly improved the survival and even cure rates of many malignant tumors, but currently the most effective chemotherapy regimen is only more effective than supportive care Improved annual overall survival. The popularization of the concept of personalized medicine in the past decade has brought new hope to advanced patients. Compared with standard chemotherapy regimens, tyrosine kinase inhibitors have improved progression-free survival.
- / , -With the development of imaging technology and radiation planning and processing methods, hyperfractionated image guidance has emerged, also known as "stereotactic radiosurgery" (R), stereotactic radiotherapy (BR) or stereotactic ablation. Radiotherapy (BR) has significantly improved tumor control rate, patient tolerance and treatment convenience. Local control of B () can be achieved - and has become the standard therapy for early-stage patients who have lost the chance of surgery.
- / , - Patients with limited site and number of metastases are called "oligo-metastasis". The prognosis of patients with oligometastasis is better than that of patients with extensive metastasis. About 1/2 patients can survive long-term after all metastases are removed. Surgical resection of metastases was the only local treatment method for patients with oligometastases in the past, but now it has entered the B era.
- / , -Definition of oligometastatic state
- / , -One of the characteristics of cancer is its ability to invade other organs from the primary tumor through blood, lymphatic metastasis or direct spread. Whether tumor cells can develop into clinically detectable metastases depends on the characteristics of the tumor cells and the environment in which they implant, similar to the relationship between seeds and soil. For decades, patients with oligometastases have often been treated with aggressive surgery or systemic radiotherapy and chemotherapy in clinical practice, and local treatment has been of very limited value.
- / , - Proposed the "spectral theory", which believes that the state of oligometastasis reflects the inactive biological behavior of tumor cells in the body. Ablation treatment of all known metastases can prolong disease-free survival and even cure patients. This theory is supported by many clinical experiences. For example, liver resection in patients with liver metastases from colorectal cancer and lung resection in patients with sarcoma lung metastases have improved long-term survival.
- / , -More and more clinical studies have also noted the significance of aggressive local therapy for advanced patients, but the difficulty lies in how to define oligometastatic status and how to determine which type of patients are more likely to benefit from ablation therapy benefit from. In published literature, the definition is mostly based on the number of metastases in clinical data, and each metastasis is defined as oligometastasis. However, recent clinical trial data suggest that a comprehensive analysis should be based on tumor volume, progression rate, histological characteristics, genetic characteristics, and tumor location. Evaluate.
- / , -Due to the current lack of unified criteria for defining oligometastasis status, some researchers classify patients based on the time and progression of metastasis. Metastasis present at the initial diagnosis is called de novo oligometastasis, while metastasis still exists after systemic treatment. The remaining metastases are called induced/persistent oligometastases. Other classifications include oligo-relapse and oligo-progression. Oligo-relapse refers to a small number of metastatic lesions that appear after treatment, while oligo-progression refers to patients with systemic therapy whose disease is stable and only a small number of lesions begin to progress.
- / , -Clinical characteristics of oligometastasis
- / , -Oligometastasis is a common manifestation in the late stage, but its exact incidence is not clear. In clinical practice, it is based on the total number of metastases and/ or the number of organs involved to make a diagnosis. Oligometastases most commonly occur in the lungs, brain, and adrenal glands, followed by the liver, spleen, and bones.
- / , -A Harvard study showed the presence of oligometastases in approximately 10% of advanced-stage patients, while a phase 1 clinical trial of oxaliplatin and paclitaxel from the University of Chicago showed the presence of oligometastases in more than 10% of metastatic patients. Japanese scholars conducted a prospective study to evaluate the occurrence of oligometastases in patients who underwent complete surgical resection. The results showed that patients had recurrence at distant sites, among which 10% were metastases. American scholars also found similar incidence rates among early patients. These data indicate the presence of a substantial proportion of patients with oligometastases.
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