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Cancers Feb 2024The concept of oligometastasis is not yet fully established in the field of gastric cancer. However, metastatic lesions that are localized, technically resectable at... (Review)
Review
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.
PubMed: 38339424
DOI: 10.3390/cancers16030673 -
Translational Cancer Research Aug 2020Metastatic breast cancer (MBC) is generally considered incurable. However, MBC which has limited number and sites of metastasis: oligometastatic breast cancer (OMBC) may... (Review)
Review
Metastatic breast cancer (MBC) is generally considered incurable. However, MBC which has limited number and sites of metastasis: oligometastatic breast cancer (OMBC) may have definitive remission with individualized, metastasis-directed ablative therapies and multidisciplinary management, such as surgery and radiotherapy. Earlier detection of primary metastatic breast cancer using accurate imaging technologies may allow the initiation of therapy for OMBC. In breast cancer, the lymph nodes, liver, bone, lung, and brain are common sites of metastasis. Additional studies are recommended if signs or symptoms indicate metastasis. The imaging modality should be selected for suspicious locations or original metastatic regions. The standard staging studies are ultrasonography for lymph node metastasis, abdominal and/or pelvic contrast-enhanced CT for liver metastasis, chest CT for pulmonary metastasis, and bone scan for bone metastasis. FDG-PET/CT may be helpful for bone or liver metastasis. MRI may be considered for liver, soft tissue, or brain metastasis.
PubMed: 35117868
DOI: 10.21037/tcr.2020.01.04 -
Cancer Research and Treatment Jan 2023
PubMed: 36596725
DOI: 10.4143/crt.2023.265 -
Medicina (Kaunas, Lithuania) Nov 2023Oligometastasis is defined as the presence of several limited metastatic lesions and is generally limited to three or fewer than five metastatic lesions. Previously, the... (Review)
Review
Oligometastasis is defined as the presence of several limited metastatic lesions and is generally limited to three or fewer than five metastatic lesions. Previously, the treatment of metastatic cancer aimed to alleviate symptoms rather than cure them; however, the use of immunotherapy or targeted therapy has greatly improved patient life expectancy. Additionally, the effectiveness and safety of local treatment have recently been proven for oligometastatic cancers and have significantly improved patient survival and decreased recurrence rates. A few metastatic studies on lung cancer have demonstrated the usefulness of combining radiation therapy and immunotherapy. Recently, local and targeted therapy combinations have shown promising results in treating non-small cell lung cancer, predominantly caused by the epidermal growth factor receptor and anaplastic lymphoma kinase gene mutations, suggesting the potential of these new treatment strategies. It is well known that oligometastasis has better clinical results than polymetastasis; however, research on the biological profile of oligometastasis is still lacking. Studies using circulating tumor DNA and circulating tumor cells are at the initial stages of providing a better understanding of oligometastatic cancers, and the biological characteristics of these cancers may be revealed based on more diverse studies. With the development of these treatments, the prognosis for patients with oligometastatic cancers is steadily improving, and if the biological profile is revealed, customized treatment may be provided.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Prognosis
PubMed: 38003982
DOI: 10.3390/medicina59111934 -
International Journal of Radiation... Nov 2022Up to 40% of patients who present with, or later develop, metastatic disease from head and neck squamous cell carcinoma have oligometastatic disease, defined as 5 or... (Review)
Review
Up to 40% of patients who present with, or later develop, metastatic disease from head and neck squamous cell carcinoma have oligometastatic disease, defined as 5 or fewer sites of metastasis. Patients with limited number of metastases clearly have improved overall survival compared with those with more disseminated metastases, but the risk of, and factors associated with, true oligometastatic state in head and neck cancer are not yet known. Current standard of care for patients with metastatic disease is single agent or combination systemic therapy, but the data are accumulating on the role of both metastasis-directed local ablative therapy and locoregional radiation therapy to improve outcomes. Although surgical resection has been the treatment of choice to address oligometastasis historically, stereotactic ablative radiotherapy has become a viable and less invasive alternative option with encouraging retrospective data in head and neck cancers. Biomarkers to help identify the oligometastatic state and prospective studies to better elucidate the role of local therapies are urgently needed.
Topics: Head and Neck Neoplasms; Humans; Prospective Studies; Radiosurgery; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 35798219
DOI: 10.1016/j.ijrobp.2022.06.086 -
Cancers Jan 2019Oligometastatic disease is defined as "a condition with a few metastases arising from tumors that have not acquired a potential for widespread metastases." Its behavior... (Review)
Review
Oligometastatic disease is defined as "a condition with a few metastases arising from tumors that have not acquired a potential for widespread metastases." Its behavior suggests a transitional malignant state somewhere between localized and metastatic cancer. Treatment of oligometastatic disease is expected to achieve long-term local control and to improve survival. Historically, patients with oligometastases have often undergone surgical resection since it was anecdotally believed that surgical resection could result in progression-free or overall survival benefits. To date, no prospective randomized trials have demonstrated surgery-related survival benefits. Short courses of highly focused, extremely high-dose radiotherapies (e.g., stereotactic radiosurgery and stereotactic ablative body radiotherapy (SABR)) have frequently been used as alternatives to surgery for treatment of oligometastasis. A randomized study has demonstrated the overall survival benefits of stereotactic radiosurgery for solitary brain metastasis. Following the success of stereotactic radiosurgery, SABR has been widely accepted for treating extracranial metastases, considering its efficacy and minimum invasiveness. In this review, we discuss the history of and rationale for the local treatment of oligometastases and probe into the implementation of SABR for oligometastatic disease.
PubMed: 30678111
DOI: 10.3390/cancers11020133 -
British Journal of Cancer Jan 2021Metastasis-directed therapy (MDT)-local therapy that is intended to eradicate specific metastatic lesions-has hitherto been used with varying degrees of clinical... (Review)
Review
Metastasis-directed therapy (MDT)-local therapy that is intended to eradicate specific metastatic lesions-has hitherto been used with varying degrees of clinical efficacy and acceptance as a meaningful therapy for metastatic disease. Over the past 25 years, however, the momentum for using MDT to manage patients with metastatic solid tumours has increased, driven by several factors. Among these factors is the recognition that patients with limited metastatic burden could potentially derive survival benefits from MDT. Furthermore, although current systemic therapies are increasingly effective, they are infrequently curative. In addition, technological advances have broadened the spectrum of metastatic lesions that can be treated with ablative intent. Here we aim to briefly review the status of evidence for the clinical benefit of MDT based on current data mainly from trials in patients with oligometastatic disease, discuss the myriad of clinical states that might fall under and beyond the definition of oligometastasis, review technological advances in MDT and their applications beyond oligometastasis, and discuss the need for the continued co-evolution of MDT and systemic therapy as we seek to understand which patients with metastatic cancer can achieve durable remission and how to optimally manage those who cannot.
Topics: Antineoplastic Agents; Humans; Neoplasm Metastasis; Neoplasms
PubMed: 33204024
DOI: 10.1038/s41416-020-01128-5 -
Clinical & Translational Oncology :... Oct 2023Oligometastasic breast cancer (OMBC) consists of breast cancer patient with a limited number of systemic metastases (≤ 5), all of them candidates for local ablative... (Review)
Review
Oligometastasic breast cancer (OMBC) consists of breast cancer patient with a limited number of systemic metastases (≤ 5), all of them candidates for local ablative treatment with the intention of achieving long-term control of the metastasis and, eventually, an increase in survival The first consensus for the management of patients with oligometastatic breast cancer (OMBC) was published in 2007, establishing that a more aggressive multidisciplinary strategy is recommended in order to increase the survival while maintaining a good quality of life. The current scientific evidence is based on observational studies, mainly retrospective, systematic reviews and meta-analyses, and only a randomized nonexclusive study of oligometastatic (OM) published. All trials with Stereotactic Body Radiation Therapy (SBRT) in OM cancer have shown excellent tolerance and good local control, although first trials on Lung SBRT did not prove so excellent tolerance and had some deaths due to bronchus irradiation and secondary hemoptysis. There are multiple ongoing studies researching the benefit of SBRT in oligometastatic breast cancer. Despite the lack of impact on survival seen in the NRG BR-002 Trial, SBRT probably allows the delay of the systemic treatment until progression, and so, improves the quality of life of patients. We have to wait for the results of the ongoing and future studies for clarification of the role of local treatment in OMBC.
Topics: Humans; Female; Breast Neoplasms; Retrospective Studies; Quality of Life; Radiosurgery
PubMed: 37106239
DOI: 10.1007/s12094-023-03170-0 -
Radiation Oncology (London, England) May 2020During these last years, new agents have dramatically improved the survival of the metastatic patients. Oligometastases represent a continuous field of interest in which... (Review)
Review
BACKGROUND
During these last years, new agents have dramatically improved the survival of the metastatic patients. Oligometastases represent a continuous field of interest in which the integration of metastases-directed therapy and drugs could further improve the oncologic outcomes. Herein a narrative review is performed regarding the main rationale in combining immunotherapy and target therapies with SBRT looking at the available clinical data in case of oligometastatic NSCLC, Melanoma and Kidney cancer.
MATERIAL AND METHOD
Narrative Review regarding retrospective and prospective studies published between January 2009 to November 2019 with at least 20 patients analyzed.
RESULTS
Concerning the combination between SBRT and Immunotherapy, the correct sequence of remains uncertain, and seems to be drug-dependent. The optimal patients' selection is crucial to expect substantial benefits to SBRT/Immunotherapy combination and, among several factors. A potential field of interest is represented by the so-called oligoprogressed disease, in which SBRT could improve the long-term efficacy of the existing target therapy.
CONCLUSIONS
A low tumor burden seems to be the most relevant, thus making the oligometastatic disease represent the ideal setting for the use of combination therapies with immunological drugs.
Topics: Combined Modality Therapy; Humans; Immunotherapy; Neoplasm Metastasis; Patient Selection; Radiosurgery; Radiotherapy Dosage; Treatment Outcome; Tumor Burden
PubMed: 32366258
DOI: 10.1186/s13014-020-01544-0 -
Radiation Oncology (London, England) Oct 2014The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging... (Review)
Review
The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging evidence has shown an oligometastatic state, an intermediate state between limited primary cancer and polymetastatic cancer, in which local therapy for metastatic lesions results in satisfactory survival comparable to non-metastatic disease. We provide a comprehensive introduction of evidence from experimental and clinical studies in favor of the oligometastatic phenotype, we review the efficacy and safety of surgery and stereotactic body radiotherapy in the treatment of oligometastases, and finally, we discuss the way to differentiate the oligometastatic state from polymetastasis.
Topics: Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms; Prognosis
PubMed: 25359216
DOI: 10.1186/s13014-014-0230-6