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Editorial

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4 pages, 191 KiB

Open AccessEditorial

Estimating the Prevalence of a True Oligometastatic Disease

by Petr Szturz, Pierluigi Bonomo and Jan B. Vermorken

Cancers 2023, 15(1), 214; https://doi.org/10.3390/cancers15010214 - 30 Dec 2022

Viewed by 1109

Abstract

To delineate a patient group with few distant metastases that could possibly benefit from a curative therapeutic strategy employing a local approach, the term oligometastatic disease (OMD) was introduced into the clinical practice almost 30 years ago [...] Full article

(This article belongs to the Special Issue Oligometastatic Disease)

7 pages, 794 KiB

Open AccessEditorial

Oligometastatic Cancer: Key Concepts and Research Opportunities for 2021 and Beyond

by Petr Szturz and Jan B. Vermorken

Cancers 2021, 13(11), 2518; https://doi.org/10.3390/cancers13112518 - 21 May 2021

Cited by 10 | Viewed by 1879

Abstract

Traditionally, clinicians distinguished three forms of cancer outgrowth [...] Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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Research

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17 pages, 1836 KiB

Open AccessArticle

Surgical Resection of Pulmonary Metastases from Melanoma in Oligometastatic Patients: Results from a Multicentric Study in the Era of Immunoncology and Targeted Therapy

by Elisa Meacci, Dania Nachira, Maria Teresa Congedo, Mohsen Ibrahim, Gianluca Pariscenti, Francesco Petrella, Monica Casiraghi, Alessandro De Stefani, Laura del Regno, Ketty Peris, Elizabeth Katherine Anna Triumbari, Giovanni Schinzari, Ernesto Rossi, Leonardo Petracca-Ciavarella, Maria Letizia Vita, Marco Chiappetta, Alessandra Siciliani, Valentina Peritore, Mattia Manitto, Lucia Morelli, Edoardo Zanfrini, Diomira Tabacco, Giuseppe Calabrese, Claudia Bardoni, Jessica Evangelista, Lorenzo Spaggiari and Stefano Margaritora Show full author list Hide full author list

Cancers 2023, 15(9), 2462; https://doi.org/10.3390/cancers15092462 - 25 Apr 2023

Cited by 1 | Viewed by 1494

Abstract

In the last decade, the emergence of effective systemic therapies (ESTs) in the form of both targeted and immuno-based therapies has revolutionized the treatment of patients with advanced stage III and stage IV melanoma. Even though lungs represent the most frequent site of [...] Read more.

In the last decade, the emergence of effective systemic therapies (ESTs) in the form of both targeted and immuno-based therapies has revolutionized the treatment of patients with advanced stage III and stage IV melanoma. Even though lungs represent the most frequent site of melanoma metastases, only limited data are available on the role of surgery in isolated pulmonary metastases from malignant melanoma (PmMM) in the era of ESTs. The aim of this study is to describe the outcomes of patients who underwent metastasectomy of PmMM in the era of ESTs, in order to identify prognostic factors affecting survival and to provide a framework for more informed patient selection of treatmeant with lung surgery in the future. Clinical data of 183 patients who underwent metastasectomy of PmMM between June 2008 and June 2021 were collected among four Italian Thoracic Centers. The main clinical, surgical and oncological variables reviewed were: sex, comorbidities, previous oncological history, melanoma histotypes and primary site, date of primary cancer surgical treatment, melanoma growth phase, Breslow thickness, mutation pattern disease, stage at diagnosis, metastatic sites, DFI (Disease Free Interval), characteristics of lung metastases (number, side, dimension, type of resection), adjuvant therapy after lung metastasectomy, site of recurrence, disease-free survival (DFS) and cancer-specific survival (CSS; defined as the time interval between the first melanoma resection or lung metastasectomy and death from cancer). All patients underwent surgical resection of the primary melanoma before lung metastasectomy. Twenty-six (14.2%) patients already had a synchronous lung metastasis at the time of primary melanoma diagnosis. A wedge resection was performed in 95.6% of cases to radically remove the pulmonary localizations, while an anatomical resection was necessary in the remaining cases. The incidence of major post-operative complications was null, while only 21 patients (11.5%) developed minor complications (mainly air leakage followed by atrial fibrillation). The mean in-hospital stay was 4.46 ± 2.8 days. Thirty- and sixty-day mortality were null. After lung surgery, 89.6% of the population underwent adjuvant treatments (47.0% immunotherapy, 42.6% targeted therapy). During a mean FUP of 107.2 ± 82.3 months, 69 (37.7%) patients died from melanoma disease, 11 (6.0%) from other causes. Seventy-three patients (39.9%) developed a recurrence of disease. Twenty-four (13.1%) patients developed extrapulmonary metastases after pulmonary metastasectomy. The CSS from melanoma resection was: 85% at 5 years, 71% at 10 years, 54% at 15 years, 42% at 20 years and 2% at 25 years. The 5- and 10-year CSS from lung metastasectomy were 71% and 26%, respectively. Prognostic factors negatively affecting CSS from lung metastasectomy at multivariable analysis were: melanoma vertical growth (p = 0.018), previous metastatic sites other than lung (p < 0.001) and DFI < 24 months (p = 0.007). Our results support the evidence that surgical indication confirms its important role in stage IV melanoma with resectable pulmonary metastases, and selected patients can still benefit from pulmonary metastasectomy in terms of overall cancer specific survival. Furthermore, the novel systemic therapies may contribute to prolonged survival after systemic recurrence following pulmonary metastasectomy. Patients with long DFI, radial growth melanoma phase and no site of metastatization other than lung seem to be the best candidate cases for lung metastasectomy; however, to drive stronger conclusions, further studies evaluating the role of metastasectomy in patients with iPmMM are needed. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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10 pages, 1294 KiB

Open AccessArticle

Impact of Progressive Site-Directed Therapy in Oligometastatic Castration-Resistant Prostate Cancer on Subsequent Treatment Response

by Soichiro Yoshida, Taro Takahara, Yuki Arita, Kazuma Toda, Koichiro Kimura, Hajime Tanaka, Minato Yokoyama, Yoh Matsuoka, Ryoichi Yoshimura and Yasuhisa Fujii

Cancers 2022, 14(3), 567; https://doi.org/10.3390/cancers14030567 - 23 Jan 2022

Cited by 4 | Viewed by 2817

Abstract

The purpose of this study was to evaluate the impact of progressive site-directed therapy (PSDT) for oligometastatic castration-resistant prostate cancer (OM-CRPC) on the efficacy of subsequent androgen receptor axis-targeted (ARAT) drugs, and to demonstrate the possibility of prolonging overall survival (OS). We performed [...] Read more.

The purpose of this study was to evaluate the impact of progressive site-directed therapy (PSDT) for oligometastatic castration-resistant prostate cancer (OM-CRPC) on the efficacy of subsequent androgen receptor axis-targeted (ARAT) drugs, and to demonstrate the possibility of prolonging overall survival (OS). We performed a retrospective analysis of 15 OM-CRPC patients who underwent PSDT and subsequently received first-line ARAT drugs (PSDT group) and 13 OM-CRPC patients who were treated with first-line ARAT drugs without PSDT (non-PSDT group). PSDT was performed with the intention of treating all progressing sites detected by whole-body diffusion-weighted MRI with radiotherapy. Thirteen patients (86.7%) treated with PSDT had a decrease in PSA levels, which was at least 50% in 10 (66.7%) patients. The median PSA progression-free survival (PFS) for PSDT was 7.4 months. The median PSA-PFS for ARAT was 27.2 months in patients in the PSDT group and 11.7 months in the non-PSDT group, with a significant difference between the two groups (hazard ratio [HR], 0.28; p = 0.010). The median OS was not reached in the PSDT group and was significantly longer than 44.5 months in the non-PSDT group (HR, 0.11; p = 0.014). In OM-CRPC, PSDT may improve the efficacy of subsequent ARAT and OS. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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12 pages, 2402 KiB

Open AccessArticle

Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients

by Franziska Walter, Maya Rottler, Lukas Nierer, Guillaume Landry, Justus Well, Paul Rogowski, Konrad Mohnike, Max Seidensticker, Jens Ricke, Claus Belka and Stefanie Corradini

Cancers 2021, 13(24), 6250; https://doi.org/10.3390/cancers13246250 - 13 Dec 2021

Cited by 6 | Viewed by 2970

Abstract

Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed [...] Read more.

Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. Patients undergoing iBT between August 2017and March 2019 were included. A retrospective analysis of patient outcomes and treatment complications was performed. Patients treated for metastatic colorectal carcinoma (CRC) were compared to other histologies. A total of 141 iBT procedures were performed in 106 patients (male:52; female:54) and 244 liver metastases. Overall, 51% (54/106) of patients had a diagnosis of metastatic CRC. The median follow-up was 9 months, and overall survival (OS) was 92.3% at 6 months and 76.3% at 12 months. Local-relapse-free survival (LRFS) was 88.4% at 6 months and 71.5% at 12 months, with a significant difference between patients with CRC (84.1% and 50.6%) versus other histologies (92.4% and 92.4%, p < 0.001). A sub-group analysis showed a significant advantage in patients with CRC receiving a minimal dose (D100) of 20 Gy to the planning target volume. Treatments of smaller total liver-tumor volumes (<18 ccm) resulted in better LRFS rates. iBT is a safe and effective treatment approach for oligometastatic liver disease. A higher treatment dose is needed for patients with CRC. Moreover, lower metastatic burdens may be favorable for LRFS. Prospective studies are needed to assess the role of iBT in the oligometastatic setting as an alternative to other local ablative treatment approaches in patients with liver metastases. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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9 pages, 721 KiB

Open AccessArticle

Endoscopic Ultrasound-Guided Radiofrequency Ablation as an Future Alternative to Pancreatectomy for Pancreatic Metastases from Renal Cell Carcinoma: A Prospective Study

by Brice Chanez, Fabrice Caillol, Jean-Philippe Ratone, Christian Pesenti, Philippe Rochigneux, Géraldine Pignot, Jeanne Thomassin, Serge Brunelle, Jochen Walz, Naji Salem, Marc Giovannini and Gwenaelle Gravis

Cancers 2021, 13(21), 5267; https://doi.org/10.3390/cancers13215267 - 20 Oct 2021

Cited by 9 | Viewed by 1944

Abstract

Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare, are associated with favorable outcomes and are usually handled by surgery or VEGFR inhibitors, which both have side effects. Endoscopic Ultrasound (EUS)-guided radiofrequency ablation (RFA) is an innovative approach to treat focally [...] Read more.

Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare, are associated with favorable outcomes and are usually handled by surgery or VEGFR inhibitors, which both have side effects. Endoscopic Ultrasound (EUS)-guided radiofrequency ablation (RFA) is an innovative approach to treat focally deep metastases and could be a relevant technique to control PM from RCC. Methods: This monocentric, prospective study aimed to evaluate the safety and efficacy of EUS-RFA to treat PM. We included patients with confirmed and progressive PM from RCC. PM was ablated under general anesthesia with a linear EUS scope and a EUS-RFA 19-gauge needle electrode placed into the tumor. Results: Twelve patients from Paoli-Calmettes Institute were recruited between May 2017 and December 2019. Median age was 70.5 years (range 61–75), 50% were female, 100% were ECOG 0–1. At inclusion, mean PM size was 17 mm (range 3–35 mm); and all were progressive before EUS-RFA. Seven patients had EUS-RFA as the only treatment for RCC. We performed 26 EUS-RFA procedures and 21 PM was ablated. Median follow up was 27.7 months (range 6.4–57.1). For evaluable PM, the 6- and 12-month focal control rates were 84% and 73% respectively. One patient treated with TKI developed a paraduodenal abscess 2 months after EUS-RFA and another patient with biliary stent developed hepatic abscesses few days after EUS-RFA. No other severe side effects were experienced. Conclusions: in this series, which is the largest ever reported, we showed that EUS-RFA is feasible and yields an excellent local control rate for PM from mRCC. With manageable complications, it could be a valuable alternative to pancreatic surgery in well-selected patients. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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14 pages, 1167 KiB

Open AccessArticle

Oligometastatic Disease Detection with ⁶⁸Ga-PSMA-11 PET/CT in Hormone-Sensitive Prostate Cancer Patients (HSPC) with Biochemical Recurrence after Radical Prostatectomy: Predictive Factors and Clinical Impact

by Carlos Artigas, Romain Diamand, Qaid Ahmed Shagera, Nicolas Plouznikoff, Fabrice Fokoue, François-Xavier Otte, Thierry Gil, Alexandre Peltier, Dirk Van Gestel and Patrick Flamen

Cancers 2021, 13(19), 4982; https://doi.org/10.3390/cancers13194982 - 04 Oct 2021

Cited by 11 | Viewed by 2448

Abstract

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and [...] Read more.

Metastasis-directed therapy (MDT) in oligometastatic prostate cancer has the potential of delaying the start of androgen deprivation therapy (ADT) and disease progression. We aimed to analyze the efficacy of PSMA-PET/CT in detecting oligometastatic disease (OMD), to look for predictive factors of OMD, and to evaluate the impact of PSMA-PET/CT findings on clinical management. We retrospectively analyzed a homogeneous population of 196 hormone-sensitive prostate cancer patients (HSPC), considered potential candidates for MDT, with a PSMA-PET/CT performed at biochemical recurrence (BCR) after radical prostatectomy (RP). Multivariable logistic regression analysis was performed based on several clinico-pathological factors. Changes in clinical management before and after PSMA-PET/CT were analyzed. The OMD detection rate was 44% for a total positivity rate of 60%. PSMA-PET/CT positivity was independently related to PSA (OR (95% CI), p) (1.7 (1.3–2.3), p < 0.0001) and PSAdt (0.4 (0.2–0.8), p = 0.013), and OMD detection was independently related to PSA (1.6 (1.2–2.2), p = 0.001) and no previous salvage therapy (0.3 (0.1–0.9), p = 0.038). A treatment change was observed in 58% of patients, mostly to perform MDT after OMD detection (60% of changes). This study showed that PSMA-PET/CT is an excellent imaging technique to detect OMD early in HSPC patients with BCR after RP, changing therapeutic management mostly into MDT. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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Review

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12 pages, 3676 KiB

Open AccessReview

Stereotactic Body Radiation Therapy in Gynecologic Oligometastases: An Effective but Underutilized Approach

by Zohaib Sherwani, Shreel Parikh, Nikhil Yegya-Raman, Kelly McKenna, Matthew Deek, Salma Jabbour and Lara Hathout

Cancers 2023, 15(13), 3526; https://doi.org/10.3390/cancers15133526 - 07 Jul 2023

Viewed by 1688

Abstract

Historically, the role of radiation in gynecological metastatic disease involved palliation for pain or bleeding. Stereotactic Body Radiation Therapy (SBRT) has shown survival benefits in oligometastatic disease from varying primary histologies in recent randomized trials. However, gynecologic primary oligometastases have been underrepresented in [...] Read more.

Historically, the role of radiation in gynecological metastatic disease involved palliation for pain or bleeding. Stereotactic Body Radiation Therapy (SBRT) has shown survival benefits in oligometastatic disease from varying primary histologies in recent randomized trials. However, gynecologic primary oligometastases have been underrepresented in these trials. Recent studies across gynecological malignancy types have similarly shown favorable outcomes and acceptable toxicities from treating recurrent or oligometastatic gynecologic cancer (ROMGC) patients with definitive radiation therapy. The largest body of literature reported on the use of SBRT in ovarian cancer, which was found to be an effective option, especially in the setting of chemo-resistant disease. Despite the encouraging outcomes using SBRT in oligometastatic gynecologic malignancies, SBRT remains underutilized given the lack of randomized studies studying ROMGC with long term follow-up. While waiting for future prospective trials to establish the role of SBRT as the standard of care in ROMGC patients, this review focuses on reporting the advantages and drawbacks of this technique and examines the current literature to help guide patient centered treatment decisions. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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20 pages, 1298 KiB

Open AccessFeature PaperReview

Oligometastatic Non-Small Cell Lung Cancer: A Practical Review of Prospective Trials

by Atallah Baydoun, VeAnn L. Lee and Tithi Biswas

Cancers 2022, 14(21), 5339; https://doi.org/10.3390/cancers14215339 - 29 Oct 2022

Cited by 5 | Viewed by 3647

Abstract

Oligometastatic non-small cell lung cancer (NSCLC) is an intermediate state between localized and widely metastatic NSCLC, where systemic therapy in combination with aggressive local therapy when feasible can yield a favorable outcome. While different societies have adopted different definitions for oligometastatic NSCLC, the [...] Read more.

Oligometastatic non-small cell lung cancer (NSCLC) is an intermediate state between localized and widely metastatic NSCLC, where systemic therapy in combination with aggressive local therapy when feasible can yield a favorable outcome. While different societies have adopted different definitions for oligometastatic NSCLC, the feasibility of curative intent treatment remains a major determinant of the oligometastatic state. The management involves a multidisciplinary approach to identify such patients with oligometastatic stage, including the presence of symptomatic or potentially symptomatic brain metastasis, the presence of targetable mutations, and programmed death-ligand (PD-L1) expression. Treatment requires a personalized approach with the use of novel systemic agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with or without chemotherapy, and addition of local ablative therapy via surgery or stereotactic radiation therapy when appropriate. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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10 pages, 453 KiB

Open AccessReview

Oligometastatic Disease: When Stage IV Breast Cancer Could Be “Cured”

by Maria Gion, Cristina Saavedra, Jose Perez-Garcia and Javier Cortes

Cancers 2022, 14(21), 5229; https://doi.org/10.3390/cancers14215229 - 25 Oct 2022

Cited by 2 | Viewed by 2591

Abstract

Although metastatic breast cancer remains an incurable disease, there are patients with a limited number of metastatic lesions that, in addition to systemic therapy, can be treated with “radical therapy” and sometimes reach the status of no long-term evidence of disease. Whether or [...] Read more.

Although metastatic breast cancer remains an incurable disease, there are patients with a limited number of metastatic lesions that, in addition to systemic therapy, can be treated with “radical therapy” and sometimes reach the status of no long-term evidence of disease. Whether or not these patients can be considered cured is still a matter of debate. Unfortunately, the definition of the oligometastatic disease remains unclear, and it can occur with multiple different presentations. The absence of remarkable biomarkers, the difficulty in designing the appropriate clinical trials, and the failure to offer this group of patients radical approaches in advanced-stage clinical trials are just some of the current problems that we face in treating patients with oligometastatic breast cancer. Although most of the data come from retrospective studies and do not use the same definition of “oligometastatic disease,” here we review the main studies exploring the role of surgery or radiotherapy in patients with the oligometastatic disease and the different results. Some, but not all, studies have shown an increase in survival when surgery and/or radiotherapy were performed for oligometastatic disease. However, better clinical trial designs are needed to confirm the role of “aggressive” approaches for patients with breast cancer and oligometastatic disease. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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14 pages, 714 KiB

Open AccessReview

Oligometastatic Head and Neck Cancer: Challenges and Perspectives

by Houda Bahig, Shao Hui Huang and Brian O’Sullivan

Cancers 2022, 14(16), 3894; https://doi.org/10.3390/cancers14163894 - 11 Aug 2022

Cited by 9 | Viewed by 4366

Abstract

A minority of patients with metastatic head and neck squamous cell carcinoma (HNSCC) present with oligometastatic disease. Oligometastasis not only reflects a disease state, but might also present an opportunity for cure in the metastatic setting. Radical ablation of all oligometastatic sites may [...] Read more.

A minority of patients with metastatic head and neck squamous cell carcinoma (HNSCC) present with oligometastatic disease. Oligometastasis not only reflects a disease state, but might also present an opportunity for cure in the metastatic setting. Radical ablation of all oligometastatic sites may confer prolonged survival and possibly achieve cure in some patients. However, substantial debate remains about whether patients with oligometastatic disease could benefit from curative intent therapy or whether aggressive treatments expose some patients to futile toxicity. Optimal selection of patients, carefully balancing the currently known prognostic factors against the risks of toxicity is critical. Emerging evidence suggests that patients with a limited burden of disease, viral-related pharyngeal cancer, metachronous metastasis and lung-only metastasis may benefit most from this approach. Efforts are underway to identify biomarkers that can detect oligometastasis and better select patients who would derive the maximum benefit from an aggressive radical approach. The combination of radiotherapy and immunotherapy promises to enhance the anti-tumoral immune response and help overcome resistance. However, optimization of management algorithms, including patient selection, radiation dose and sequencing, will be critical in upcoming clinical trials. This review summarizes recent knowledge about the characteristics and investigational efforts regarding oligometastasis in HNSCC. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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12 pages, 2917 KiB

Open AccessReview

The Road to Dissemination: The Concept of Oligometastases and the Barriers for Widespread Disease

by Hamza AlGhamdi, Jennifer Dhont, Mohammad Krayem, Pauline De Bruyn, Benedikt Engels, Dirk Van Gestel and Robbe Van den Begin

Cancers 2022, 14(8), 2046; https://doi.org/10.3390/cancers14082046 - 18 Apr 2022

Cited by 5 | Viewed by 2896

Abstract

Over the last years, the oligometastatic disease state has gained more and more interest, and randomized trials are now suggesting an added value of stereotactic radiotherapy on all macroscopic disease in oligometastatic patients; but what barriers could impede widespread disease in some patients? [...] Read more.

Over the last years, the oligometastatic disease state has gained more and more interest, and randomized trials are now suggesting an added value of stereotactic radiotherapy on all macroscopic disease in oligometastatic patients; but what barriers could impede widespread disease in some patients? In this review, we first discuss the concept of oligometastatic disease and some examples of clinical evidence. We then explore the route to dissemination: the hurdles a tumoral clone has to overtake before it can produce efficient and widespread dissemination. The spectrum theory argues that the range of metastatic patterns encountered in the clinic is the consequence of gradually obtained metastatic abilities of the tumor cells. Tumor clones can obtain these capabilities by Darwinian evolution, hence early in their genetic progression tumors might produce only a limited number of metastases. We illustrate selective dissemination by discussing organ tropism, the preference of different cancer (sub)types to metastasize to certain organs. Finally we discuss biomarkers that may help to distinguish the oligometastatic state. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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18 pages, 15159 KiB

Open AccessReview

Imaging of Oligometastatic Disease

by Naik Vietti Violi, Rami Hajri, Laura Haefliger, Marie Nicod-Lalonde, Nicolas Villard and Clarisse Dromain

Cancers 2022, 14(6), 1427; https://doi.org/10.3390/cancers14061427 - 10 Mar 2022

Cited by 4 | Viewed by 2445

Abstract

Oligometastatic disease (OMD) is an emerging state of disease with limited metastatic tumor burden. It should be distinguished from polymetastatic disease due the potential curative therapeutic options of OMD. Imaging plays a pivotal role in the diagnosis and follow-up of patients with OMD. [...] Read more.

Oligometastatic disease (OMD) is an emerging state of disease with limited metastatic tumor burden. It should be distinguished from polymetastatic disease due the potential curative therapeutic options of OMD. Imaging plays a pivotal role in the diagnosis and follow-up of patients with OMD. The imaging tools needed in the case of OMD will differ according to different parameters, which include primary tumor type, timing between measurement and treatment, potential metastatic location and the patient’s individual risk for metastasis. In this article, OMD is defined and the use of different imaging modalities in several oncologic situations are described in order to better understand OMD and its specific implication for radiologists. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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17 pages, 323 KiB

Open AccessReview

Oligometastatic Disease in Non-Small-Cell Lung Cancer: An Update

by Yi-Hsing Chen, Ue-Cheung Ho and Lu-Ting Kuo

Cancers 2022, 14(5), 1350; https://doi.org/10.3390/cancers14051350 - 06 Mar 2022

Cited by 3 | Viewed by 3178

Abstract

Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC [...] Read more.

Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC has been proposed, and this may facilitate trial design and evaluation of certain interventions. Patients with oligometastatic NSCLC are candidates for curative-intent management, in which local ablative treatment, such as surgery or stereotactic radiosurgery, should be instituted to improve clinical outcomes. Although current guidelines recommend that local therapy for thoracic and metastatic lesions should be considered for patients with oligometastatic NSCLC with stable disease after systemic therapy, optimal management strategies for different oligometastatic sites have not been established. Additionally, the development of personalized therapies for individual patients with oligometastatic NSCLC to improve their quality of life and overall survival should also be addressed. Here, we review relevant articles on the management of patients with oligometastatic NSCLC and categorize the disease according to the site of metastases. Ongoing trials are also summarized to determine future directions and expectations for new treatment modalities to improve patient management. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

Other

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15 pages, 673 KiB

Open AccessPerspective

Stereotactic Body Radiotherapy and Immunotherapy for Older Patients with Oligometastases: A Proposed Paradigm by the International Geriatric Radiotherapy Group

by Nam P. Nguyen, Ahmed Ali, Vincent Vinh-Hung, Olena Gorobets, Alexander Chi, Thandeka Mazibuko, Natália Migliore, Maria Vasileiou, David Lehrman, Mohammad Mohammadianpanah, Seyed Alireza Javadinia, Gokoulakrichenane Loganadane, Trinanjan Basu, Satya Bose, Ulf Karlsson and Huan Giap

Cancers 2023, 15(1), 244; https://doi.org/10.3390/cancers15010244 - 30 Dec 2022

Cited by 3 | Viewed by 2275

Abstract

The standard of care for metastatic disease is systemic therapy. A unique subset of patients with limited metastatic disease defined as distant involvement of five anatomic sites or less (oligometastases) have a better chance of remission or improved survival and may benefit from [...] Read more.

The standard of care for metastatic disease is systemic therapy. A unique subset of patients with limited metastatic disease defined as distant involvement of five anatomic sites or less (oligometastases) have a better chance of remission or improved survival and may benefit from local treatments such as surgery or stereotactic body radiotherapy (SBRT). However, to prevent further spread of disease, systemic treatment such as chemotherapy, targeted therapy, and hormonal therapy may be required. Older patients (70 years old or above) or physiologically frail younger patients with multiple co-morbidities may not be able to tolerate the conventional chemotherapy due to its toxicity. In addition, those with a good performance status may not receive optimal chemotherapy due to concern about toxicity. Recently, immunotherapy with checkpoint inhibitors (CPI) has become a promising approach only in the management of program death ligand 1 (PD-L1)-positive tumors. Thus, a treatment method that elicits induction of PD-L1 production by tumor cells may allow all patients with oligometastases to benefit from immunotherapy. In vitro studies have demonstrated that high dose of radiotherapy may induce formation of PD-L1 in various tumors as a defense mechanism against inflammatory T cells. Clinical studies also corroborated those observations. Thus, SBRT, with its high precision to minimize damage to normal organs, may be a potential treatment of choice for older patients with oligometastases due to its synergy with immunotherapy. We propose a protocol combining SBRT to achieve a minimum radiobiologic equivalent dose around 59.5 Gy to all tumor sites if feasible, followed four to six weeks later by CPI for those cancer patients with oligometastases. All patients will be screened with frailty screening questionnaires to identify individuals at high risk for toxicity. The patients will be managed with an interdisciplinary team which includes oncologists, geriatricians, nurses, nutritionists, patient navigators, and social workers to manage all aspects of geriatric patient care. The use of telemedicine by the team may facilitate patient monitoring during treatment and follow-up. Preliminary data on toxicity, local control, survival, and progression-free survival may be obtained and serve as a template for future prospective studies. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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22 pages, 13863 KiB

Open AccessSystematic Review

Stereotactic Body Radiation Therapy in Patients with Oligometastatic Disease: Clinical State of the Art and Perspectives

by Rémy Kinj, Emilien Muggeo, Luis Schiappacasse, Jean Bourhis and Fernanda G. Herrera

Cancers 2022, 14(5), 1152; https://doi.org/10.3390/cancers14051152 - 23 Feb 2022

Cited by 8 | Viewed by 4043

Abstract

Stereotactic body radiation therapy (SBRT) is a form of radiation therapy (RT) in which a small number of high doses of radiation are delivered to a target volume using highly sophisticated equipment. Stereotactic body radiation therapy is crucial in two cancer stages: early [...] Read more.

Stereotactic body radiation therapy (SBRT) is a form of radiation therapy (RT) in which a small number of high doses of radiation are delivered to a target volume using highly sophisticated equipment. Stereotactic body radiation therapy is crucial in two cancer stages: early primary cancer and oligometastatic disease, with the goal of inducing complete cancer remission in both. This treatment method is commonly used to treat a variety of disease types. Over the years, a growing body of clinical evidence on the use of SBRT for the treatment of primary and metastatic tumors has accumulated, with efficacy and safety demonstrated in randomized clinical trials. This article will review the technical and clinical aspects of SBRT according to disease type and clinical indication. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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13 pages, 839 KiB

Open AccessSystematic Review

Stereotactic Body Radiotherapy for Patients with Lung Oligometastatic Disease: A Five-Year Systematic Review

by Guillaume Virbel, Clara Le Fèvre, Georges Noël and Delphine Antoni

Cancers 2021, 13(14), 3623; https://doi.org/10.3390/cancers13143623 - 20 Jul 2021

Cited by 8 | Viewed by 2241

Abstract

For several years, oligometastatic disease has represented an intermediate state between localized disease accessible to local treatment and multimetastatic disease requiring systemic therapy. The lung represents one of the most common metastatic locations. Stereotactic body radiation therapy (SBRT) appears to be the treatment [...] Read more.

For several years, oligometastatic disease has represented an intermediate state between localized disease accessible to local treatment and multimetastatic disease requiring systemic therapy. The lung represents one of the most common metastatic locations. Stereotactic body radiation therapy (SBRT) appears to be the treatment of choice for these patients. There are few data defining the place of radiotherapy and reporting outcome after SBRT in lung metastases. This 5-year review aimed to determine areas of SBRT usefulness and methods for the management of pulmonary metastasis in oligometastatic patients. A search for articles on PubMed allowed selection of the most relevant studies. Eighteen articles were selected according to pre-established criteria for this purpose. The analysis concludes that SBRT is an effective and safe treatment in selected patients when the disease remains localized from one to three organs. Full article

(This article belongs to the Special Issue Oligometastatic Disease)

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