OLIGOMETASTATIC BREAST CANCER
Learn about oligometastatic breast cancer, including symptoms, treatment, radiation therapy and the latest research from Breast Cancer Trials.
Oligometastatic breast cancer is a form of metastatic (stage 4) breast cancer where the cancer has spread beyond the breast to only a small number of other sites in the body.
While metastatic breast cancer is often associated with more widespread disease, oligometastatic breast cancer represents a subset with a smaller volume of disease that may allow additional treatment approaches for some people.
Advances in imaging, radiation therapy, surgery and systemic treatments have led researchers to investigate whether treating these limited areas of cancer more intensively could improve outcomes for selected patients. Breast cancer clinical trials continue to explore the role of personalised treatment approaches for people with oligometastatic breast cancer.
What is Oligometastatic Breast Cancer?
Oligometastatic breast cancer is a term used to describe breast cancer that has spread beyond the breast and local lymph nodes to a limited number of distant sites, rather than being widely distributed throughout the body. In most cases, oligometastatic disease refers to up to five metastatic tumours, although the exact definition may vary depending on the clinical trial or treatment approach. These metastases are typically confined to only a small number of organs.
The most common sites of oligometastatic breast cancer include the bones, liver, lungs and brain. Unlike more widespread metastatic breast cancer, where cancer has spread to many locations, oligometastatic disease is confined to only a small number of areas.
In simpler terms, if you think of metastatic breast cancer as a large network of many tumour spots, oligometastatic breast cancer is like having just a few spots. This smaller number of metastases can sometimes make it possible to treat with a combination of local treatments, such as surgery or radiation therapy, and systemic treatments like hormone therapy, chemotherapy or targeted therapies.
Like metastatic breast cancer, most people with oligometastatic breast cancer have previously been treated for early breast cancer. For a small percentage of patients, this is their first diagnosis of breast cancer.
Some examples of oligometastatic breast cancer are metastatic breast cancer with 2 lung metastases, or metastatic breast cancer with 3 bone metastases.
“Now, oligometastatic breast cancer has some similarities to metastatic breast cancer in that there are metastases that are distant from the breast and the nearby lymph nodes, but there is a limited number of metastases, so typically with oligometastatic breast cancer there’s a maximum of up to five metastases, so it’s a small number of metastases.” – Professor Prue Francis
Is Oligometastatic Breast Cancer the Same as Stage 4 Breast Cancer?
Yes. Oligometastatic breast cancer is a subtype of stage 4 (metastatic) breast cancer because the cancer has spread beyond the breast and local lymph nodes to another part of the body.
The difference is that oligometastatic breast cancer involves only a small number of metastatic sites, whereas more widespread metastatic breast cancer has spread to multiple areas of the body.
Because the amount of cancer in the body is less, some people with oligometastatic breast cancer may be suitable for additional local treatments, such as surgery or stereotactic radiation therapy, alongside systemic treatments like hormone therapy, chemotherapy or targeted therapies. However, treatment recommendations are individualised and depend on factors including the location and number of metastases, the breast cancer subtype, previous treatments and a person’s overall health.
As research into oligometastatic breast cancer is continuing to evolve, clinical trials are helping researchers better understand which patients may benefit most from these treatment approaches.
Oligometastatic vs Metastatic Breast Cancer
While oligometastatic breast cancer is a form of metastatic breast cancer, there are some important differences in how the disease may present and how it may be managed.
Learn more about metastatic breast cancer, including symptoms, diagnosis and treatment.
What Are the Symptoms of Oligometastatic Breast Cancer?
The symptoms of oligometastatic breast cancer are similar to those of metastatic breast cancer and depend on where the cancer has spread. The most common sites of spread include the bones, liver, lungs and brain, although breast cancer can spread to other parts of the body.
Some people may experience symptoms, while others have few or no symptoms when oligometastatic breast cancer is first diagnosed. Symptoms can vary depending on the location of the metastases and may include:
- Persistent bone pain or aches
- Shortness of breath or an ongoing cough
- Headaches or changes in vision
- Abdominal pain or discomfort
- Fatigue or unexplained weight loss
Many of these symptoms can also be caused by conditions other than breast cancer. If you notice any new, persistent or worsening symptoms, speak with your doctor or treatment team so they can determine the cause and recommend any appropriate tests or treatment.
For more information about the symptoms, diagnosis and treatment of metastatic breast cancer, visit our Metastatic Breast Cancer page.
How Is Oligometastatic Breast Cancer Treated?
Treatment for oligometastatic breast cancer is highly personalised and depends on several factors, including the number and location of the metastases, the time at which they developed, the breast cancer subtype, previous treatments and a person’s overall health.
Most patients with oligometastatic breast cancer are treated similarly to patients with non-oligometastatic breast cancer with systemic therapy that works throughout the whole body to control the cancer for as long as possible. Local therapies, most commonly radiotherapy but sometimes also surgery, are used when required for management of symptoms such as pain.
But for a subset of patients with oligometastatic cancer, treatment can also include intensive local therapies. This is because oligometastatic breast cancer involves only a limited number of metastatic sites and it is possible to treat all of these sites with treatments designed to ablate, or destroy the cancer.
Intensive local treatments used in the management of oligometastatic breast cancer may include:
- Radiation therapy, including stereotactic radiation therapy (sometimes called stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR)) which uses high dose radiation beams to destroy cancer cells at particular sites within the body.
- Surgery, in selected situations where it may help remove isolated metastatic tumours.
- Other therapies, like cryotherapy or thermal ablative therapy to burn the cancer cells with extreme cold or heat. These treatments are used less commonly.
Systemic treatment options used in conjunction with intensive local therapies may include:
- Endocrine (hormone) therapy for hormone receptor-positive breast cancer.
- Targeted therapies, including HER2-targeted treatments and other medicines matched to the biology of the cancer.
- Chemotherapy, depending on the breast cancer subtype and previous treatments.
- Immunotherapy for triple negative breast cancer.
Researchers continue to investigate how different combinations of local and systemic treatments may improve outcomes for selected people with oligometastatic breast cancer. Clinical trials are helping determine which patients are most likely to benefit from these personalised treatment approaches.
Listen to the Podcast
We spoke to Prue and Steven about oligometastatic breast cancer from the perspectives of a Medical Oncologist and a Radiation Oncologist, and the current standard treatment approaches for this disease.
Key Takeaways
- Oligometastatic breast cancer is a type of metastatic breast cancer with only a small number of tumours (usually up to five). Researchers are studying whether it may benefit from different treatment approaches.
- Treatment is becoming more personalised and may combine systemic therapies with local treatments, such as surgery or stereotactic radiation therapy.
- Not everyone with oligometastatic breast cancer will be suitable for local treatment, and decisions are made on an individual basis.
- Highly targeted radiation can effectively treat individual tumours, but it’s not yet clear if it helps people live longer. More clinical trials are needed before it becomes standard treatment.
- Clinical trials continue to investigate which treatment approaches provide benefit to patients.
What are the goals of local treatment in oligometastatic breast cancer?
The goal of treatment in select patients with oligometastatic breast cancer, is to provide intensive treatment to the cancer whilst it has only spread to limited number of sites in the body. In combination with systemic therapy, this intensive local therapy aims to prolong the time until the breast cancer progresses and ultimately help patients live better, for longer.
The use of radiation in oligometastatic disease is different to that used in metastatic breast cancer. In oligometastatic disease, high doses of radiotherapy are used to ablate the cancer and try and kill as many cancer cells as possible. In contrast, in metastatic breast cancer, lower doses of radiotherapy are given to try and kill enough cancer cells to manage cancer symptoms.
Whilst high dose radiation is safe in patients with oligometastatic breast cancer, it is not known if intensive local treatment in oligometastatic prolongs patient survival but studies are underway to test this theory.
Is there a role for surgery and radiotherapy to the breast in oligometastatic breast cancer?
For some patients with oligometastatic breast cancer the breast cancer had already spread by the time it was first diagnosed. As a result, they still have cancer in their breast and nearby lymph nodes.
Management of the breast and nearby lymph nodes in oligometastatic breast cancer is purely to prevent problems from the cancer, such a large cancer wounds, bleeding, pain, lymphoedema or weakness and sensory changes in the arm. Studies have not shown an improvement in survival for patients with metastatic breast cancer treated with breast surgery and radiotherapy.
What Are the Primary Goals of Radiation Therapy When Treating Oligometastatic Breast Cancer?
Radiation therapy is increasingly being used as a local therapy to treat selected people with oligometastatic breast cancer. Advances in technology now allow radiation to be delivered with much greater precision, helping target small metastatic tumours while minimising damage to surrounding healthy tissue. Where technically possible, radiotherapy has the advantage of ablating areas of cancer within the body without requiring surgery.
Associate Professor Steven David explains:
- Radiation therapy in the last 10 years has developed a new technique, made possible by advances in technology, called stereotactic radiation.
- It can be delivered to almost any part of the body and is different from conventional radiation because it can be delivered like a laser beam – very accurately, very quickly, and with very few side effects to the surrounding healthy tissue.
- This has led researchers to ask whether we can use this technique to eliminate oligometastatic tumours. In some cases, treatment can be delivered in just one or two sessions, with excellent local control of the cancer within the treated area.
How Do You Determine if a Patient with Breast Cancer is Suitable for Radiation Therapy?
Not everyone with oligometastatic breast cancer will be suitable for radiation therapy. Treatment decisions are based on several factors, including the location, number and size of the metastases, previous treatments, and the potential risks and benefits for each individual.
Associate Professor Steven David explains that advances in radiation technology have made it possible to treat more people with oligometastatic breast cancer than ever before. However, radiation therapy is not suitable for every situation. For example, if a metastasis is located close to a critical structure such as the spinal cord, it may not be possible to safely deliver radiation without causing damage to surrounding healthy tissue.
Doctors consider the location, number and size of the metastases, as well as whether a person has previously received radiation therapy, before determining whether this treatment is appropriate.
Associate Professor David also discusses the current evidence for radiation therapy in oligometastatic breast cancer. Early studies suggested there may be a survival benefit from treating a small number of metastatic sites with radiation or surgery in people whose disease was otherwise well controlled with systemic therapy. However, these studies included relatively few people with breast cancer.
More recent research focusing specifically on breast cancer has shown that while radiation therapy can effectively control individual metastatic sites, it has not yet been shown to improve overall survival. More research is needed before this approach can be routinely recommended for everyone with oligometastatic breast cancer.
“We know we can safely deliver local radiation to these sites and potentially control them, but whether this ultimately improves a person’s overall journey with metastatic breast cancer and their survival has not yet been clearly shown in breast cancer. More research is needed before this approach can be routinely recommended.” – Adapted from Associate Professor Steven David’s podcast interview
Breast Cancer Trials Research
Oligometastatic breast cancer is an evolving area of research, and while treatment approaches continue to advance, many questions remain about which patients are most likely to benefit from more intensive local treatments, such as surgery or stereotactic radiation therapy.
Breast cancer clinical trials are helping researchers better understand how to personalise treatment for people with oligometastatic breast cancer, including when local therapies should be combined with systemic treatments such as hormone therapy, chemotherapy or targeted therapies. They are also investigating whether these approaches can improve outcomes while maintaining quality of life.
Breast Cancer Trials is committed to improving outcomes for people with breast cancer through world-leading clinical research. Every Breast Cancer Trials study contributes valuable knowledge that helps shape future treatment decisions and supports the development of more personalised care.
Explore our achievements to see how Breast Cancer Trials research has helped shape breast cancer treatment in Australia, New Zealand and around the world.
Frequently Asked Questions
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What is oligometastatic disease?
Oligometastatic disease describes breast cancer that has spread from its original location to only a limited number of distant sites in the body. In breast cancer, this is known as oligometastatic breast cancer and is considered a subtype of metastatic (stage 4) breast cancer. Because the disease is limited, treatment approaches may differ for some people.
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Is oligometastatic breast cancer stage 4?
Yes. Oligometastatic breast cancer is a form of stage 4 (metastatic) breast cancer because it has spread beyond the breast. However, it differs from more widespread metastatic breast cancer because there are only a limited number of metastatic sites, which may influence treatment options for some people.
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What is the difference between oligometastatic and metastatic breast cancer?
Oligometastatic breast cancer is a subtype of metastatic breast cancer where the disease has spread to only a small number of sites. More widespread metastatic breast cancer involves multiple metastatic sites throughout the body. Because the disease is more limited, treatment approaches may differ for some people with oligometastatic breast cancer.
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Can oligometastatic breast cancer be cured?
Oligometastatic breast cancer is still considered metastatic breast cancer, and there is currently no established cure. However, some people may benefit from a combination of systemic therapies and local treatments that aim to control the disease, delay progression and maintain quality of life. Researchers continue to investigate whether these approaches can improve long-term outcomes.
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Is radiation therapy used to treat oligometastatic breast cancer?
Yes, radiation therapy may be used for some people with oligometastatic breast cancer to treat individual metastatic sites. Whether radiation therapy is appropriate depends on factors such as the location, number and size of the metastases, previous treatments and the individual’s overall treatment plan.
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Transcript
Professor Prue Francis is the Clinical Head of Breast Medical Oncology at the Peter MacCallum Cancer Centre and a Consultant Medical Oncologist at St Vincent’s Hospital in Melbourne. She Chaired the International Steering Committee responsible for the SOFT and TEXT clinical trials, that have led to practice changes practice in the management of young women with hormone receptor positive early breast cancer.
Associate Professor Steven David is an experienced Radiation Oncologist at the Peter MacCallum Cancer Centre, bringing a strong interest in implementing cutting edge radiation technology to provide his patients with the highest level of care.
We spoke to Prue and Steven about oligometastatic breast cancer from the perspectives of a Medical Oncologist and a Radiation Oncologist, and the current standard treatment approaches for this disease.
Oligometastatic breast cancer is a term used to describe a specific situation in breast cancer. When breast cancer spreads beyond the original tumor, it’s called metastasis. Most metastatic breast cancer involves multiple spread-out tumors in various places.
However, in oligometastatic breast cancer, the cancer has spread but only to a limited number of places—typically, just a few distant spots like the bones, liver, or lungs. It’s different from more widespread metastasis because the cancer is not as scattered or extensive.
In simpler terms, if you think of metastatic breast cancer as a large network of many new tumor spots, oligometastatic breast cancer is like having just a few new spots. This smaller number of metastases can sometimes make it easier to treat and manage, often with a combination of local treatments (like surgery or radiation) and systemic treatments (like hormone therapy or chemotherapy).
The goal with oligometastatic breast cancer is often to control or reduce the spread and potentially extend the time before the cancer progresses further.
“So, traditionally we think of breast cancer as either being an early stage breast cancer, where the cancer is confined to the breast or the breast and the regional or the nearby lymph nodes, and then we talk about metastatic breast cancer where actually there is a spread of the breast cancer to a place that is distant from the breast and the nearby lymph nodes, for example the bone, the lung or the liver,” Prue said.
“Now, oligometastatic breast cancer has some similarities to metastatic breast cancer in that there are metastases that are distant from the breast and the nearby lymph nodes, but there is a limited number of metastases, so typically with oligometastatic breast cancer there’s a maximum of up to five metastases, so it’s a small number of metastases.”
What are some of the current standard treatment approaches for oligometastatic breast cancer?
“Well, typically, oligometastatic breast cancer would be treated more like metastatic breast cancer, and if there are a very limited number of distant metastases, for example, some patients might have only one distant metastasis, the question that arises is: could that patient actually be treated perhaps more like early breast cancer, but with some additional technique to try and eradicate that problem site, that single site of distant metastasis?”
“And so that’s why we try to think more carefully about this situation. We lack evidence for that sort of approach, but this is something that we think about, and we want to study,” she said.
What are some of the primary goals of radiation therapy when treating oligometastatic breast cancer?
“So, radiation therapy in the last 10 years has developed a new technique or a new modality of delivering radiation and it’s due to technology, and that technique or technology is called stereotactic radiation,” said Steven.
“It can be delivered to any part of the body and it’s different from any other type of radiation in that it can be delivered like a laser beam, very accurately, very quickly, and with almost none or very few side effects to anything around where you’re aiming it at.”
“And so immediately what people have thought about in oligometastatic breast cancer is why don’t we use that technique to eliminate the oligometastases or destroy them? We can do that very quickly in maybe 10 or 15 minutes with one or two treatments, with excellent long-term outcomes in terms of killing off the cancer in that spine,” he said.
How do you determine if a patient with breast cancer is suitable for radiation therapy?
“So, in the oligometastatic setting as technology has gotten better, we can distribute it more broadly, and in more situations. But there are some scenarios where you can’t do it. For example, if a metastasis is right near something that is very critical such as the spinal cord, it’s almost impossible to kill that deposit without also killing the spinal cord, and then it would be disastrous for a patient,” he said.
“So, location, number of metastases, size of metastases, and also if the patient’s had previous radiation, let’s say for a breast cancer, and then an oligometastases is nearby, it makes it very challenging because you’re overlapping with treatment you’ve given in the past. And so those are the sorts of factors we look at and think about.”
“When we decide if someone’s safe for oligometastatic treatment. One of the earlier studies that was done in oligometastatic breast cancer was looking at patients with a few different types of malignancies. There was lung cancer, there might have been prostate cancer, breast cancer, different types of malignancies, but all with a small number of metastatic sites.”
“And this trial was trying to look at if those patients had their disease otherwise controlled by a drug therapy that they’d started on, if they could try to deliver a dose of either radiation or perhaps surgery to a site, could you actually give them a better outcome by eradicating those local tumours, and just focusing on those distant metastases?”
“And that trial suggested that there was a survival advantage. It was not a very large trial, but it suggested that there was a survival advantage. But the number of breast cancer patients in the trial was relatively small. It wasn’t only a trial looking at breast cancer.”
“Then more recently, there’s been a trial that was trying to address this question again, but in a specific breast cancer population. And again, thinking about whether trying to eradicate those small number of sites of distant metastases could lead to a better outcome in terms of survival. And, in fact, that follow up trial actually did not show a benefit in overall survival.”
“So, I think we’re in a situation where we know we can deliver local radiation to these sites and potentially get some control of those sites, but whether that actually ultimately impacts the patient’s overall journey with metastatic breast cancer and their survival has not actually been clearly shown in breast cancer.”
“So, we really need more information to say that we should be doing this, really to routinely offer this. So, it remains really something that needs to be proven for breast cancer.”
In what ways does personalised medicine play a role in treating oligometastatic breast cancer?
“It’s a good question and I think I can answer it with starting with examples of two different sorts of patients. So, for example, there might be a patient who had breast cancer 15 years ago and had it treated successfully. And then 15 years later, they develop one bone metastasis. That patient has oligometastatic disease. A similar patient, in my case, has oligometastatic disease, and turns up with three bone metastases on the same day that they’re diagnosed with their primary, and that’s part one,” said Steven.
“And part two is, there are patients with different subtypes of breast cancer. We talked about HER2-positive, there’s triple negative, and there’s other types. So, these trials generally group all those patients together and call them all oligometastatic patients, and we now know that there’s different types of oligometastatic disease, and so I think whenever you start research you group everyone together and try and find a bit of an answer to a global question because it’s very hard to recruit very narrow groups of patients.”
“But I think where we’re heading now is really looking at subtype specific patients and researching them differently because we do believe that it’s possible there might be very different answers for those different patients. So that’s the subject of ongoing research and investigation,” he said.
What are your hopes for the future?
“Well, in the oligometastatic setting the attractive thing is that it has never been thought that you could cure metastatic disease, and really that’s something across all of cancer. So, it’s a bit of a prior golden egg, a prize really, patients would love it and doctors obviously would love it if we could cure stage four disease,” said Steven.
“And I’ve seen Prue give a talk on that topic, on HER2-positive breast cancers, and she thinks they will be cured sometime soon. And perhaps radiation stereotactic to small deposits may be part of that story. And I think that would be a fantastic thing to talk about and to be able to say to patients, we’re going to cure you, even though it’s spread beyond the breast. And there’s every chance that’ll be in our lifetime, I think,” he said.
“I think in the area of oligometastatic disease, we have a few new tools in our kit bag from a drug therapy point of view that haven’t previously been tested formally in patients with oligometastatic disease. They’re things that we now would use in a higher risk, early-stage breast cancer patients,” said Prue.
“For example, a PARP inhibitor in a patient with a BRCA mutation or a CDK4/6 inhibitor in a patient with ER-positive HER2-negative high-risk disease, or perhaps immunotherapy in a high-risk triple negative breast cancer patient.”
“So, the question is, if we were to apply these types of therapies in the context of the overall treatment paradigm for a patient with an oligometastatic disease with those specific features, could that translate into any difference in a patient with a very limited number of metastases? Could that translate into any cures? Because at this stage we don’t have good information on how that would work with those newer therapies,” she said.“Now, oligometastatic breast cancer has some similarities to metastatic breast cancer in that there are metastases that are distant from the breast and the nearby lymph nodes, but there is a limited number of metastases, so typically with oligometastatic breast cancer there’s a maximum of up to five metastases, so it’s a small number of metastases.” – Professor Prue Francis
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Information Sources
https://pubmed.ncbi.nlm.nih.gov/33237270/
https://ascopubs.org/doi/10.1200/JCO.2022.40.16_suppl.1007
https://pubmed.ncbi.nlm.nih.gov/41263247/
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32487-5/abstract
https://ascopubs.org/doi/10.1200/JCO.2022.40.16_suppl.1007
Last updated: July 2026
Clinical review: Dr Sarah Zardawi and Dr Nicholas Zdenkowski
Expert insights informed by interviews with: Professor Prue Francis and Associate Professor Steven David.
Podcast published: August 2024
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