Definition of oligometastatic esophagogastric cancer and impact of local oligometastasis-directed treatment: A systematic review and meta-analysis

Kroese, Tiuri E.; Laarhoven, H.W.M. van; Nilsson, Magnus; Lordick, Florian; Gückenberger, Matthias; Ruurda, Jelle P.; D’Ugo, Domenico; Haustermans, Karin; Cutsem, Éric Van; Hillegersberg, Richard van; Rossum, Peter S.N. van

doi:10.1016/j.ejca.2022.02.018

Cited by 56 publications

(61 citation statements)

References 104 publications

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“…This definition was comparable with recent literature on OMD in esophagogastric cancer. 14 However, perhaps this definition of OMD should not be applicable to the brain as OMD in this organ is associated with worse OS. 31 A universal multidisciplinary consensus statement is warranted to initiate future trials in this field.…”

Section: Discussionmentioning

confidence: 99%

“…OMD was limited to 1 organ or 1 extraregional lymph node station with B 3 lesions. 14 Patients who underwent local treatment and/or systemic therapy for oligometastases were included. Patients who underwent best supportive care were not included.…”

Section: Patient Inclusionmentioning

confidence: 99%

“…However, most studies define OMD as a maximum of 3 lesions in 1 organ. [12][13][14] Several, small, retrospective, nonrandomized studies suggest that local treatment (i.e., metastasectomy or stereotactic body radiotherapy (SBRT)) for oligometastatic esophagogastric cancer may improve overall survival (OS). [15][16][17][18][19] However, because these studies have been focusing on patients who underwent local treatment and have not included patients who underwent systemic therapy alone, the general applicability of these studies remains unclear.…”

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confidence: 99%

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Metastasectomy or Stereotactic Body Radiation Therapy With or Without Systemic Therapy for Oligometastatic Esophagogastric Cancer

et al. 2022

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Background The primary goal of this study was to determine overall survival (OS) in patients who underwent local treatment (metastasectomy or stereotactic body radiotherapy [SBRT]) or systemic therapy (chemotherapy or targeted therapy) for oligometastatic esophagogastric cancer. The secondary goal was to determine prognostic factors for OS. Methods Patients with synchronous or metachronous oligometastatic esophagogastric cancer who underwent local treatment or systemic therapy were included in this single-center, retrospective cohort study. Oligometastatic disease (OMD) included 1 organ or 1 extraregional lymph node station with ≤ 3 lesions. OS was determined after OMD detection. Treatment for OMD was categorized as (1) local treatment, (2) local plus systemic, (3) systemic therapy. The primary tumor was controlled after resection or definitive chemoradiotherapy. Results In total, 85 patients were included. Treatment for OMD was local treatment (58%), local plus systemic (14%), or systemic therapy (28%). The primary tumor was controlled in 68% of patients. Most patients were diagnosed with distal esophageal cancer (61%), with adenocarcinoma histology (76%), and presented with synchronous OMD (51%). OS after local treatment was 17 months (95% confidence interval [CI] 12–40), after local plus systemic therapy 35 months (95% CI 29–NA), and after systemic therapy 16 months (95% CI 11–NA). Better OS was independently associated with local plus systemic compared with local treatment (hazard ratio [HR] 2.11, 95% CI 1.05–5.07) or systemic therapy (HR 2.28, 95% CI 1.04–6.07). Conclusions Local plus systemic therapy for oligometastatic esophagogastric cancer was independently associated with improved OS and better OS compared with either systemic therapy or local treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Inclusionmentioning

confidence: 99%

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confidence: 99%

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Metastasectomy or Stereotactic Body Radiation Therapy With or Without Systemic Therapy for Oligometastatic Esophagogastric Cancer

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“…Generally speaking, the term oligometastatic disease is defined as either a limited number and/or volume of metastatic lesions and applies to a number of different malignancies [ 6 , 7 , 8 ]. Typically, studies defining and evaluating outcomes of patients with oligometastatic disease use their own study-specific definition of oligometastatic disease, which often ranges from 1–5 metastatic lesions.…”

Section: Historical Definition Of Oligometastatic Disease and Relevan...mentioning

confidence: 99%

Defining Oligometastatic Disease in the New Era of PSMA-PET Imaging for Primary Staging of Prostate Cancer

Galgano

McDonald

West

et al. 2022

Cancers

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Oligometastatic prostate cancer has traditionally been defined in the literature as a limited number of metastatic lesions (either to soft tissue or bone), typically based on findings seen on CT, MRI, and skeletal scintigraphy. Although definitions have varied among research studies, many important clinical trials have documented effective treatments and prognostication in patients with oligometastatic prostate cancer. In current clinical practice, prostate-specific membrane antigen (PSMA)-PET/CT is increasingly utilized for the initial staging of high-risk patients and, in many cases, detecting metastases that would have otherwise been undetected with conventional staging imaging. Thus, patients with presumed localized and/or oligometastatic prostate cancer undergo stage migration based on more novel molecular imaging. As a result, it is challenging to apply the data from the era before widespread PET utilization to current clinical practice and to relate current trials using PSMA-PET/CT for disease detection to older studies using conventional staging imaging alone. This manuscript aims to review the definition of oligometastatic prostate cancer, summarize important studies utilizing both PSMA-PET/CT and conventional anatomic imaging, discuss the concept of stage migration, and discuss current problems and challenges with the current definition of oligometastatic disease.

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“…In 1995, Hellman and Weichselbaum first proposed oligometastatic disease as a distinct cancer state between locally confined and systemic metastatic disease [ 100 ], which refers to a metastatic tumor with no more than three to five metastases [ 101 , 102 , 103 , 104 , 105 , 106 ]. For these patients, some researchers claim oligometastasis-directed SBRT should be delivered to all tumor lesions to yield efficient tumor control and immune-stimulating effect [ 76 , 107 , 108 ].…”

Section: Clinical Decision Suggestionsmentioning

confidence: 99%

A ‘Hybrid’ Radiotherapy Regimen Designed for Immunomodulation: Combining High-Dose Radiotherapy with Low-Dose Radiotherapy

Zhou

2022

Cancers

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Radiotherapy (RT) affects anti-tumor immunity. However, the exact impact of RT on anti-tumor immune response differs among cancer types, RT dose and fractions, patients’ innate immunity, and many other factors. There are conflicting findings on the optimal radiation dose and fractions to stimulate effective anti-tumor immunity. High-dose radiotherapy (HDRT) acts in the same way as a double-edged sword in stimulating anti-tumor immunity, while low-dose radiotherapy (LDRT) seems to play a vital role in modulating the tumor immune microenvironment. Recent preclinical data suggest that a ‘hybrid’ radiotherapy regimen, which refers to combining HDRT with LDRT, can reap the advantages of both. Clinical data have also indicated a promising potential. However, there are still questions to be addressed in order to put this novel combination therapy into clinical practice. For example, the selection of treatment site, treatment volume, the sequencing of high-dose radiotherapy and low-dose radiotherapy, combined immunotherapy, and so on. This review summarizes the current evidence supporting the use of HDRT + LDRT, explains possible immune biology mechanisms of this ‘hybrid’ radiotherapy, raises questions to be considered when working out individualized treatment plans, and lists possible avenues to increase efficiency in stimulating anti-tumor immunity using high-dose plus low-dose radiotherapy.

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Definition of oligometastatic esophagogastric cancer and impact of local oligometastasis-directed treatment: A systematic review and meta-analysis

Cited by 56 publications

References 104 publications

Metastasectomy or Stereotactic Body Radiation Therapy With or Without Systemic Therapy for Oligometastatic Esophagogastric Cancer

Metastasectomy or Stereotactic Body Radiation Therapy With or Without Systemic Therapy for Oligometastatic Esophagogastric Cancer

Defining Oligometastatic Disease in the New Era of PSMA-PET Imaging for Primary Staging of Prostate Cancer

A ‘Hybrid’ Radiotherapy Regimen Designed for Immunomodulation: Combining High-Dose Radiotherapy with Low-Dose Radiotherapy

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