Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed

Chiapponi, Costanza; Berlth, Felix; Plum, Patrick Sven; Betzler, Christopher; Stippel, Dirk L.; Popp, Felix; Bruns, Christiane

doi:10.1159/000455683

Cited by 25 publications

(18 citation statements)

References 30 publications

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“…Radical radiotherapy of all metastases has been demonstrated to achieve long-term survival in patients with oligometastatic breast cancer 24 and lung cancer 25 . Patients with oligometastatic esophagogastric junction and gastric cancer were also found to obtain survival benefit from aggressive surgical treatment of metastases 26 . Our study is believed to be the first to demonstrate the efficacy of local treatment of metastases (whether partial or all metastases) in oligometastatic EC patients.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases

Wang

Zhang

et al. 2020

Sci Rep

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Platinum-based chemotherapy is recommended as the standard treatment for metastatic esophageal cancer (EC) patients; however, the outcome is poor. Oligometastasis is less aggressive and has limited growth potential. However, the prognostic factors for EC patients with oligometastases was largely unknown. Thus, we intend to determine the prognostic factors, and develop and validate nomograms for prediction of survival for EC patients with oligometastases. In this study, characteristics of 273 oligometastatic EC patients were analyzed using univariate and multivariate Cox models to determine the independent prognostic factors for progression-free survival (PFS) and overall survival (OS). The result showed that history of alcohol consumption, longer tumor, no local radiotherapy for EC, and no local treatment for metastases were independent factors for PFS. Sex, esophageal fistula, number of metastatic organs, and local radiotherapy for EC were independent prognostic factors for OS. On the basis of Cox models, the respective nomogram for prediction of PFS and OS was established with the corrected concordance index of 0.739 and 0.696 after internal cross-validation. In conclusion, local treatment for metastases and local radiotherapy for EC were demonstrated to be beneficial for oligometastatic EC patients, and the validated nomograms are valuable in prognosis prediction and could guide individualized management for these patients.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases

Wang

Zhang

et al. 2020

Sci Rep

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“…16 In the near future, circulating biomarkers will probably be useful in selecting patients with lymph node dissemination or distant spread for radical treatment. 20 Potential weaknesses of this study are obviously the retrospective design and the low numbers of patients included in groups 1 and 2. Furthermore, although efforts were made to obtain comparable groups in terms of extent of metastatic disease in groups 1 and 2 (single-organ oligometastatic with maximal surgical versus medical therapy), one could argue that patients with liver metastases and brain metastases have less favorable outcomes than those with adrenal and lung metastases.…”

Section: Discussionmentioning

confidence: 96%

Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

Depypere

Moons

Lerut

et al. 2018

Asian Cardiovasc Thorac Ann

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Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with potentially resectable esophageal cancer were sheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients, a potentially curative esophagectomy was performed. In 12 patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of metastases; 10 of them had oligometastatic disease (≤4 single-organ metastases). Esophagectomy was not performed in 117 patients (because of disease progression in 50); 14 were also single-organ oligometastatic. Data of 10 single-organ oligometastatic patients who underwent esophageal resection (group 1) were compared those of 10 non-resected but treated counterparts (group 2) and with 228 patients who underwent potentially curative esophagectomy with persistent pathological lymph nodes (group 3). Results Five oligometastatic esophagectomy patients had lung metastases: 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. Two oligometastatic non-resected patients had lung, 5 liver, and 3 brain metastases. Median overall survival was 21.4, 12.1, and 20.2 months in the respective groups (group 1 vs. group 2 p = 0.042; group 2 vs. group 3 p = 0.002; group 1 vs. group 3 p = 0.88). Conclusions Survival is longer in patients undergoing palliative esophagectomy with unexpected single-organ oligometastatic disease and comparable to survival in patients with persistent pathological lymph nodes. Palliative resection in these patients seems to be justified.

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“…Oligometastastic disease is de ned as less than ve distant, potentially resectable metastases, eg liver metastases and limited peritoneal carcinomatosis. It is used to described a state between limited and disseminated metastatic disease, with the potential intention of curative treatment [7]. The evidence is low with some retrospective studies suggesting prolonged survival after surgical resection of metastases from EGAC tumors [8][9][10].…”

Section: Trial Registrationmentioning

confidence: 99%

Perioperative FLOT Chemotherapy Plus Surgery for Oligometastatic Esophagogastric Adenocarcinoma: Surgical Outcome and Overall Survival

Runkel

Verst

Spiegelberg

et al. 2020

Preprint

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Background:Guidelines do not recommend surgery for patients with oligometastatic disease from esophagogastric adenocarcinoma (EGAC), although some studies suggest a more favourable survival. We analyzed the outcome of oligometastatic EGAC receiving FLOT chemotherapy followed by surgery. Methods:The data of patients with either pre-therapeutic, post-neoadjuvant or intraoperative clinical diagnosis of oligometastatic EGAC were extracted from a prospective database of the 2009-2018 treatment period. 48 consecutive patients were identified with oligometastatic disease, who underwent perioperative chemotherapy plus surgery. We retrospectively analyzed surgical outcome and overall survival. Results:The overall 5-year survival was 18 %. 12 patients with pre-therapeutic oligometastatic EGAC, who had no histologic vital tumor evidence of metastases after surgery had a survival rate of 48 % compared to an 11 % 5-year survival rate of 36 patients, who had histologic vital tumor metastatic evidence after FLOT chemotherapy and surgical resection (p=0.012). The survival rates after R0, R1 and R2 (non-resected metastases) resection were 21 % (n=33), 0 % (n=4) and 17 % (n=11), respectively (p=0.273).Conclusion:Oligometastatic EGAC is associated with poor overall survival even after complete resection of all tumor manifestations. The subgroup of patients with a complete pathohistologic response of metastatic lesions to neoadjuvant FLOT shows 5-year survival rates similar to non-metastatic EGAC. Trial registration: Not applicable

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Oligometastatic Disease in Upper Gastrointestinal Cancer - How to Proceed

Cited by 25 publications

References 30 publications

Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases

Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases

Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

Perioperative FLOT Chemotherapy Plus Surgery for Oligometastatic Esophagogastric Adenocarcinoma: Surgical Outcome and Overall Survival

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