Maladie oligométastatique dans le cancer bronchique non à petites cellules

Non-small cell lung cancers are diagnosed at a widespread metastatic stage in about half of cases. Prognosis remains poor with a median overall survival around one year. Oligometastatic non-small cell lung cancers are an infrequent feature comprising 1 to 5 metastatic sites only which may be synchrones (diagnosed within 6 months after primary site) or metachrones. The major sites which have been studied, mainly as case reports, are adrenal glands, brain, and lung in which bifocal surgery and/or stereotactic radiation therapy have been proposed associated in most instances with systemic treatment. Long term survival may be observed essentially if there is no mediastinal lymph nodes involvement. Even more infrequently, oligometastatic lung tumors involving bone, skin, liver, kidney… have been reported as being amenable to radical treatment. In those cases also, the main prognostic factor is the involvement of mediastinal nodes. The exact role of systemic treatment remains to be established as only isolated cases have been reported. It is more than probable that these oligometastatic non-small cell lung cancers which do not progress toward a polymetastatic form have a special biological profile as some studies, especially about microRNAs, suggested it recently.