Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe

Kroese, Tiuri E.; Laarhoven, Hanneke W. M. van; Schoppman, Sebastian F.; Deseyne, Pieter; Cutsem, Éric Van; Haustermans, Karin; Nafteux, Philippe; Thomas, Melissa L.; Obermannová, Radka; Mortensen, Hanna Rahbek; Nordsmark, Marianne; Pfeiffer, Per; Elme, Anneli; Adenis, Antoine; Piessen, Guillaume; Bruns, Christiane; Lordick, Florian; Gockel, Ines; Moehler, Markus; Gani, Cihan; Liakakos, Theodore; Reynolds, John V.; Morganti, Alessio Giuseppe; Rosati, Riccardo; Castoro, Carlo; Cellini, Francesco; D’Ugo, Domenico; Roviello, Franco; Bencivenga, Maria; Manzoni, Giovanni De; Henegouwen, Mark I. van Berge; Hulshoff, M; Dieren, Jolanda van; Vollebergh, Marieke A.; Sandick, Johanna W. van; Jeene, Paul M.; Muijs, C.T.; Slingerland, Marije; Voncken, Francine E.M.; Hartgrink, Henk H.; Creemers, Geert-Jan; Sangen, M.J.C. van der; Nieuwenhuijzen, G.A.P.; Berbée, Maaike; Verheij, Marcel; Wijnhoven, Bas P. L.; Beerepoot, Laurens V.; Mohammad, Nadia Haj; Mook, Stella; Ruurda, Jelle P.; Kołodziejczyk, Piotr; Polkowski, Wojciech; Wyrwicz, Lucjan; Alsina, María; Pera, Manuel; Kanonnikoff, Tania Fleitas; Cervantes, Andrés; Nilsson, Magnus; Mönig, Stefan P.; Wagner, Anna Dorothea; Gückenberger, Matthias; Griffiths, Ewen A.; Smyth, Elizabeth; Hanna, George B.; Markar, Sheraz R.; Chaudry, M. Asif; Hawkins, M.; Cheong, Edward; Hillegersberg, Richard van; Rossum, Peter S.N. van; Rozema, Tom; Heisterkamp, Joos; Schaefer, Markus; Ozsahin, E.M.; Haan, Jacco J. de; Berg, Jan Willem van den; Duprez, Frédéric; Callebout, Eduard; Daele, Elke Van; Hacker, Ulrich; Hoffmeister, Albrecht; Kuhnt, Thomas; Denecke, Timm; Kluge, Regine; Prager, Gerald W.; Ilhan-Mutlu, Aysegül; Cuicchi, Dajana; Ardizzoni, Andrea; Rosman, Camiel; Gootjes, Elske C.; Rütten, Heidi; Puccetti, Francesco; Cascinu, Stefano; Slim, N.; Barrios, Maria Eugenia; Fernández, M.C.; Martí-Oriol, Roberto; Alvaro, Marisol Huerta; Vera, Almudena; Jordá, E.; Mozos, Fernando López; Reig, A.; Visa, Laura; Ciseł, Bogumiła; Czechowska, Joanna; Kwietniewska, Magdalena; Pikuła, Agnieszka; Skórzewska, Magdalena; Kozłowska, Aleksandra; Rawicz‐Pruszyński, Karol

doi:10.1016/j.ejca.2023.02.015

Cited by 18 publications

(12 citation statements)

References 43 publications

(69 reference statements)

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“…According to the current lack of a consensus definition and treatment for oligometastasis of gastric or gastroesophageal cancer, a European multicenter board of experts organized the OligoMetastatic Esophagogastric Cancer (OMEC) Consortium to discuss and establish a definition, diagnosis, and treatment strategy for oligometastasis from gastric cancer or gastroesophageal cancer [27][28][29][30]. The OMEC Consortium consists of 50 esophagogastric cancer expert institutions in Europe, and it has been endorsed by major associations on cancer treatment, such as the European Organisation for Research and Treatment of Cancer, ESMO, and the International Gastric Cancer Association.…”

Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

“…The OMEC Consortium consists of 50 esophagogastric cancer expert institutions in Europe, and it has been endorsed by major associations on cancer treatment, such as the European Organisation for Research and Treatment of Cancer, ESMO, and the International Gastric Cancer Association. The OMEC project was conducted, which consists of five chapters, including a systematic review and meta-analysis [28], and it reached a consensus on definitions and treatments for oligometastasis based on case presentations and board meetings [27,29]. According to the OMEC project, oligometastasis is defined as limited metastasis to one organ with a maximum of three lesions or one distant lymph node metastasis in patients with synchronous metastasis.…”

Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

“…For metachronous oligometastasis in which the interval between the primary tumor and metastasis was within 2 years, upfront local treatment should be considered. After this consensus, the OMEC Consortium announced its plan to conduct a prospective randomized controlled trial in the future [27][28][29][30]. Para-aortic lymph node metastasis in station No.…”

Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

“…Solitary liver metastasis is considered a type of oligometastasis [3,29]; however, whether two or more lesions should be considered as oligometastasis remains controversial. Several recent studies have evaluated the prognostic factors for synchronous or metachronous liver metastasis from gastric cancer treated with surgical resection [21,22,[36][37][38][39][40][41] (Table 1).…”

Section: Liver Metastasismentioning

confidence: 99%

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Oligometastasis of Gastric Cancer: A Review

Yasufuku,

Tsuchiya,

Fujibayashi

et al. 2024

Cancers

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The concept of oligometastasis is not yet fully established in the field of gastric cancer. However, metastatic lesions that are localized, technically resectable at diagnosis, present a certain response to preoperative chemotherapy, and present favorable survival outcomes with local treatments, sometimes in combination with chemotherapy, are recognized as oligometastasis in the field of gastric cancer. Oligometastasis is noted in European Society for Medical Oncology guidelines and Japanese gastric cancer treatment guidelines, and local treatment is mentioned as one of the pivotal treatment options for oligometastasis. Solitary liver metastasis or a small number of liver metastases; retroperitoneal lymph node metastasis, especially localized para-aortic lymph node metastasis; localized peritoneal dissemination; and Krukenberg tumor are representative types of oligometastasis in gastric cancer. The AIO-FLOT3 trial prospectively evaluated the efficacy of multimodal treatments for gastric cancer with oligometastasis, including surgical resection of primary and metastatic lesions combined with chemotherapy, confirming favorable survival outcomes. Two phase 3 studies are ongoing to investigate the efficacy of surgical resection combined with perioperative chemotherapy compared with palliative chemotherapy. Thus far, the evidence suggests that multimodal treatment for oligometastasis of gastric cancer is promising.

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Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

Section: Oligometastatic Esophagogastric Cancer Consortiummentioning

confidence: 99%

Section: Liver Metastasismentioning

confidence: 99%

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Oligometastasis of Gastric Cancer: A Review

Yasufuku,

Tsuchiya,

Fujibayashi

et al. 2024

Cancers

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show abstract

“…In esophageal cancer, early reports suggest more aggressive treatment options appear to improve survival for oligometastatic patients [9][10][11][12][13]. There are varying definitions of esophageal oligometastatic disease; for the purposes of this study, it was defined as 5 or less foci of disease [9,14,15]. Nevertheless, guidelines do not currently distinguish between oligometastatic and extensive metastatic disease in esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Definitive Chemoradiation Associated with Improved Survival Outcomes in Patients with Synchronous Oligometastatic Esophageal Cancer

Matoska

Banerjee

Shreenivas

et al. 2023

Cancers

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Background: The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated with a definitive approach (chemoradiotherapy [CRT]) would have improved overall survival (OS) compared to those treated with a purely palliative intent and historical controls. Methods: Patients diagnosed with synchronous oligometastatic (any histology, ≤5 metastatic foci) esophageal cancer treated in a single academic hospital were retrospectively analyzed and divided into definitive and palliative treatment groups. Definitive CRT was defined as radiation therapy to the primary site with ≥40 Gy and ≥2 cycles of chemotherapy. Results: Of 78 Stage IVB (AJCC 8th ed.) patients, 36 met the pre-specified oligometastatic definition. Of these, 19 received definitive CRT, and 17 received palliative treatment. With a median follow-up of 16.5 months (Range: 2.3–95.0 months), median OS for definitive CRT and palliative groups were 90.2 and 8.1 months (p < 0.01), translating into 5-year OS of 50.5% (95%CI: 32.0–79.8%) vs. 7.5% (95%CI: 1.7–48.9%), respectively. Conclusions: Oligometastatic EC patients treated with definitive CRT benefited from that approach with survival rates (50.5%) that vastly exceeded historical standards of 5% at 5 years for metastatic EC. Oligometastatic EC patients treated with definitive CRT had significantly improved OS compared to those treated with palliative-only intent within our cohort. Notably, definitively treated patients were generally younger and with better performance status versus those palliatively treated. Further prospective evaluation of definitive CRT for oligometastatic EC is warranted.

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Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery

Brunner,

Boda-Heggemann,

Bürgy

et al. 2024

Strahlenther Onkol

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Purpose and objective To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs. Materials and methods Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60–79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process. Results Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60–79% consensus. Conclusion In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT.

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Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe

Cited by 18 publications

References 43 publications

Oligometastasis of Gastric Cancer: A Review

Oligometastasis of Gastric Cancer: A Review

Definitive Chemoradiation Associated with Improved Survival Outcomes in Patients with Synchronous Oligometastatic Esophageal Cancer

Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery

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