Cancers that have spread to organs away from their original location are labelled as “metastatic” and have generally been considered universally fatal. A diagnosis of metastatic cancer usually means treatment that is conservative, palliating symptoms and/or extending life moderately, but not curing patients. This paradigm was originally developed in the early days of cancer treatment and has generally changed little. However, with improvements in our ability to treat and diagnose, we are starting to understand that not all metastatic cancers should be considered equal. That some patients with metastatic cancer have disease spread only to a few additional organs. We have begun labeling those ...

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Cancers that have spread to organs away from their original location are labelled as “metastatic” and have generally been considered universally fatal. A diagnosis of metastatic cancer usually means treatment that is conservative, palliating symptoms and/or extending life moderately, but not curing patients. This paradigm was originally developed in the early days of cancer treatment and has generally changed little. However, with improvements in our ability to treat and diagnose, we are starting to understand that not all metastatic cancers should be considered equal. That some patients with metastatic cancer have disease spread only to a few additional organs. We have begun labeling those metastatic cancers that have spread to a limited number of organs as “oligometastatic”. We increasingly understand that these oligometastic cancers represent an intermediary step, and that if we act decisively with curative treatment, we may be able to offer much better outcomes than the traditional conservative treatments. Our research group has been the first to complete a randomized trial comparing aggressive therapy to more conservative therapy in oligometastatic lung cancer. This study found that oligometastatic patients treated with aggressive therapy were free from disease significantly longer than those treated with more conventional conservative treatment. We hope to build upon this trial and conduct a larger randomized clinical trial where oligometastatic patients with 9 of the most common cancer types: colon/rectal, lung, sarcoma, head and neck, ovarian, kidney, pancreas, prostate, and bladder receive either aggressive therapy or conservative treatment. This trial has also a number of more experimental laboratory tests designed to gain insight into the basic biology of oligometastatic disease and the effects of aggressive therapy on the entire body.

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