Title |
The oligometastatic state—separating truth from wishful thinking
|
---|---|
Published in |
Nature Reviews Clinical Oncology, June 2014
|
DOI | 10.1038/nrclinonc.2014.96 |
Pubmed ID | |
Authors |
David A. Palma, Joseph K. Salama, Simon S. Lo, Suresh Senan, Tom Treasure, Ramaswamy Govindan, Ralph Weichselbaum |
Abstract |
The oligometastatic paradigm implies that patients who develop a small number of metastatic lesions might achieve long-term survival if all these lesions are ablated with surgery or stereotactic radiotherapy. Clinical data indicate that the number of patients with oligometastatic disease receiving aggressive treatment is increasing rapidly. We examine the key evidence supporting or refuting the existence of an oligometastatic state. Numerous single-arm studies suggest that long-term survival is 'better-than-expected' after ablative treatment. However, the few studies with adequate controls raise the possibility that this long-term survival might not be due to the treatments themselves, but rather to the selection of patients based on favourable inclusion criteria. Furthermore, ablative treatments carry a risk of harming healthy tissue, yet the risk-benefit ratio cannot be quantified if the benefits are unmeasured. If the strategy of treating oligometastases is to gain widespread acceptance as routine clinical practice, there should be stronger evidence supporting its efficacy. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Spain | 2 | 15% |
United States | 2 | 15% |
Canada | 1 | 8% |
Switzerland | 1 | 8% |
Australia | 1 | 8% |
Netherlands | 1 | 8% |
United Kingdom | 1 | 8% |
Unknown | 4 | 31% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 8 | 62% |
Scientists | 4 | 31% |
Science communicators (journalists, bloggers, editors) | 1 | 8% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 2 | <1% |
Japan | 1 | <1% |
Unknown | 203 | 99% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 35 | 17% |
Researcher | 34 | 17% |
Student > Ph. D. Student | 25 | 12% |
Student > Master | 16 | 8% |
Student > Doctoral Student | 15 | 7% |
Other | 46 | 22% |
Unknown | 35 | 17% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 104 | 50% |
Agricultural and Biological Sciences | 18 | 9% |
Biochemistry, Genetics and Molecular Biology | 8 | 4% |
Physics and Astronomy | 7 | 3% |
Nursing and Health Professions | 2 | <1% |
Other | 12 | 6% |
Unknown | 55 | 27% |