Métastase unique de cancer bronchique non à petites cellules: faut-il une prise en charge particulière ?

A sub-group of patients suffering from stage IV non-small cell lung cancer is becoming more and more frequently encountered: it comprises patients who present with one single metastasis. If it can be assumed that there is no specific biological phenomenom underlying a single metasasis but a single event captured at a specific moment of time, one cannot avoid the questions of specific details of therapeutic management. The metastatic sites that are open to a multimodal approach are few and aggressive management is generally limited to pulmonary, cerebral or adrenal metastases.It is important to emphasise that this approach requires three closely related conditions: (i) an extensive search for other metastases; (ii) The possibility of local control of the primary tumour, which requires that the node status is less than N2; (iii) the addition of adjuvent chemotherapy. This last recommendation is arguable as it is not based on direct scientific data but deduced, by inference, from a large series of randomised trials of adjuvent chemotherapy. Even though an isolated metastasis from non-small cell lung cancer is probably not a biological entity distinct from the more common multiple metastatic disease, it remains true that its management stretches the limits of treatment and may change the management of all stage IV disease.