Oligiometastatic Definition

ericalynn

I am having difficulty finding the actual definition of Oligiometastatic. Can lymph nodes be involved? I was stage 4 Her2 positive with 2 spots in my liver and some chest node involvement. My understanding is it meets the criteria if it is 1-5 organs so, any further clarification would be much appreciated. Thank you to my friends

exbrnxgrl

Oligometastasis (check your spelling if looking online) is a state that more and more MO’s are accepting but that has not always been the case. This may be why you find some variations in definitions. Here is the NCI definition:

https://www.cancer.gov/publications/dictionaries/cancer-terms/def/oligometastasis

There are still some mo’s that believe any metastatic disease is just that and are still not sold on oligometastases. There is clearly some interpretation of the term in the medical community but that’s understandable since there is no test for it as anything markedly different from other mets except for their limited number and location. I am considered to have oligo mets and I had one positive lymph node.

Elderberry

Well the link said one or two. I thought (but I am not a cancer expert) that oligometastases was ONE organ that can have more than one lesion. I am not sure the lymph nodes is part of the equation, it is the distant "travelled"

"Oligo" seemed something to be cheered about. Maybe it wasn't as bad as multiple sites . But three or five strikes me as being multiple.

exbrnxgrl

There appears to be no set in stone definition of oligometastases. As I noted, it wasn't all that long ago when some MO's did not believe in limited mets. The following is from an article that I will post a link to, but helps in understanding why the term is not clearly defined.

“While there is not yet a consensus definition for oligometastases, additional terms have been coined to further describe temporal patterns of cancer spread. The terms "de novo oligometastases," or "synchronous oligometastases,"

Here’s the link: https://apm.amegroups.com/article/view/51420/html

ericalynn

Thanks Ladies,

I’m still at the beginning of this whole thing, but I THiNK I am De novo oligo. ( with just one organ involved) My MO treated me aggressively with 8 rounds of Taxotere, herceptin, and Perjeta. But, he stands in the no surgery with stage 4 - ugh.

exbrnxgrl

Ericalynn,

No breast surgery is the current standard of care for most de novo stage IV patients, so your mo is within reason. Although there is some debate (i.e. reducing total tumor load) your breasts are not essential organs so leaving the breast tumor in place does not make metastatic disease worse. I am a bit of an oddball in that although considered stage IV de novo, my bone met was found incidentally about 6 weeks after my surgery. It was a grade 1 twin to my breast tumor so it had been there a while. Interestingly, I was not treated in a way most folks think of as aggressive. I had rads to the bone met (no pain, intent was to kill it!) and have been on AI’s only for 11 years. No chemo, Ibrance, Verzenio etc. Take care.

illimae

Erica Lynn, I don’t have an exact definition either but I discovered the term mentioned in my medical summaries after being diagnosed de novo with a single bone met in 2016. I asked and was told (at least according to doctors at MDA) that it is 5 or less lesions in 2 or less distant locations. Surgery was an option for me but due to conflicting studies, they really couldn’t recommend either way. I decided to proceed with a lumpectomy and have no regrets. I was diagnosed with a few brain mets soon after (likely already seeded and slow growing) but I’m still considering oligo and haven’t had anything new pop up below the neck. Who knows if surgery made a difference or not, I’ve come to realize that cancer is very unpredictable. Luck, good or bad seems to be the only explanation sometimes.

ericalynn

Illimae,

Did they count your lymph nodes into the equation? Where were your nodes that were involved?

Thank you so much!

illimae

Erica, I don’t think so, pretty sure they only counted bone/organs. I had 3 axillary nodes and a supraclavicular node positive for BC. As far as surgery is concerned, minimal mets is key.

Anonymous

Have you had indication via scans that the primary has reduced in size due to treatment to date? I've seen a lot of early stagers marvel at how their primary shrunk to almost nothing with chemo before surgery.

I think I was on the cusp of oligo, but its not in use here in the UK. Bone only, 3 vertebrae and my sacrum, went straight to targeted therapy as per national guidelines. Never saw the term on my letters, but got a better team and have chosen more aggressive paths when given the option. Its never been spoken but I do wonder sometimes if they are, in fact, treating this as an oligo situation.

I know it is weird to leave the tumor in, but its more important to get and keep the distant mets sites controlled, especially as surgery can have complications. However, in my case my primary decided to start growing and developed resistance to Ibrance first, so it made sense at that time to go for the local option of removal. Frankly I think it was also an opportunity for the team to significantly lower my overall tumor burden by removing the last big blob of cancer so they jumped on it.

University of Chicago is the main research and proponent of this line of thought, you may want to contact them for a second opinion.