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Journal of Craniovertebral Junction &... 2020Vertebral metastases represent an important cause of cancer-related morbidity and mortality. Among all available treatments, interventional percutaneous techniques have... (Review)
Review
Vertebral metastases represent an important cause of cancer-related morbidity and mortality. Among all available treatments, interventional percutaneous techniques have recently emerged as potential strategies for the management of oncologic patients with vertebral lesions. Minimally invasive image-guided therapies include "ablative" and "consolidative" ones. According to the number of metastases and the patient's performance status, ablative techniques can be performed with a curative or a palliative purpose since necrosis induced by critic changes of intralesional temperature determines both tumor debulking and destruction of pain receptors. On the other hand, consolidative treatments are based on the injection of polymethylmethacrylate cement to improve structural vertebral integrity and obtain pain alleviation and prevention of skeletal-related events. This article reviews the current recommendations supporting the role of interventional radiology in the management of vertebral metastases, focusing on the last updates in literature.
PubMed: 32905009
DOI: 10.4103/jcvjs.JCVJS_56_20 -
European Urology Oncology Oct 2020Metastasis-directed therapy (MDT) in the form of stereotactic ablative radiation therapy (SABR), or in combination with surgical metastasectomy, may have a role in...
Targeting Oligometastasis with Stereotactic Ablative Radiation Therapy or Surgery in Metastatic Hormone-sensitive Prostate Cancer: A Systematic Review of Prospective Clinical Trials.
CONTEXT
Metastasis-directed therapy (MDT) in the form of stereotactic ablative radiation therapy (SABR), or in combination with surgical metastasectomy, may have a role in cancer control and disease progression.
OBJECTIVE
To perform a systematic review of MDT (surgery or SABR) for oligometastatic (up to 10 metastases, recurrent or de novo) hormone-sensitive prostate cancer in addition to or following primary prostate gland treatment.
EVIDENCE ACQUISITION
Medline, Embase, Cochrane Review Database, and clinical trial Databases were systematically searched for clinical trials reporting oncological outcomes and safety. The risk of bias was assessed with the Cochrane 2.0 or ROBINS-I tool.
EVIDENCE SYNTHESIS
From 1025 articles identified, four clinical trials met the prespecified criteria. These included two randomised and two nonrandomised clinical trials (n=169). Baseline prostate-specific antigen level, age, and metastasis ranged from 2.0 to 17.0 ng/ml, 43 to 75 yr, and one to seven lesions, respectively. Nodal, bone, nodal and bone, and visceral metastases were present in 49.7% (84/169), 33.7% (57/169), 15.9% (27/169), and 0.5% (1/169) of patients, respectively. Diagnostic conventional imaging was used in 43.7% (74/169) and positron emission tomography/computerised tomography in 56.2% (95/169) of patients. SABR and surgical metastasectomy with SABR were used in 78.3% (94/120) and 21.6% (26/120) of patients, respectively. Early progression-free survival ranged from 19% to 60%. Local control was reported as 93-100%. Grade II and III SABR toxicities were reported in 8% (8/100) and 1% (1/100) of patients, respectively. Grade IIIa and IIIb surgical complications were reported in 7.69% (2/26) and 0% (0/26) of patients, respectively.
CONCLUSIONS
MDT is a promising experimental therapeutic approach in men with hormone-sensitive oligometastatic prostate cancer. Randomised comparative studies are required to ascertain its role and optimal timing in oligometastatic recurrence and efficacy in de novo synchronous disease.
PATIENT SUMMARY
We looked at the evidence regarding the use of surgery or radiotherapy at target areas of cancer spread in men with newly diagnosed or relapsed advanced (metastatic) prostate cancer. Evidence supports both treatment options as promising approaches, but further large trials are required.
Topics: Ablation Techniques; Clinical Trials as Topic; Humans; Male; Neoplasm Metastasis; Prospective Studies; Prostatic Neoplasms; Radiosurgery
PubMed: 32891600
DOI: 10.1016/j.euo.2020.07.004 -
Minerva Urologica E Nefrologica = the... Oct 2020The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of...
INTRODUCTION
The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa).
EVIDENCE ACQUISITION
We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality").
EVIDENCE SYNTHESIS
After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear.
CONCLUSIONS
We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.
Topics: Humans; Male; Molecular Targeted Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prostatic Neoplasms
PubMed: 32550632
DOI: 10.23736/S0393-2249.20.03779-0 -
World Journal of Gastrointestinal... Sep 2019Oesophageal cancer is the eighth most common cancer worldwide. The prognosis of oesophageal cancer patients still remains poor. The 5-year survival rate rarely exceeds...
BACKGROUND
Oesophageal cancer is the eighth most common cancer worldwide. The prognosis of oesophageal cancer patients still remains poor. The 5-year survival rate rarely exceeds 5% in case of metastatic disease. Some patients may however present with oligometastasis which can be treated with loco-regional therapy.
AIM
To assess the current practice regarding the management of patients with oligometastatic oesophageal cancer and identify prognostic factors affecting survival following treatment for oligometastasis.
METHODS
A systematic search of the literature was performed in Cochrance Library, MEDLINE and EMBASE databases from September 1950 to January 2019. Relevant electronic databases were searched for studies assessing the clinical outcome of oligometastasis.
RESULTS
A total of 14 publications were included, of which 12 studies assessing metachronous oligometastasis and 2 on synchronous oligometastasis. All included articles evaluated the specific outcomes of metastasis, management modality and survival outcomes. The majority of the patients presented with oesophageal squamous cell carcinoma. The median disease free interval (time to recurrence) in patients was 19.6 mo and the overall survival reached 30.8 months. Unfavourable prognostic factors were assessed in eight studies and included time to recurrence < 12 mo, large diameter pulmonary lesions (> 20 mm), disease free interval (DFI) < 12 mo, extra-pulmonary metastasis, primary tumour pathological stage III/IV.
CONCLUSION
Oligometastatic oesophageal cancer in selected patients is amenable to loco-regional treatment, and the overall survival of this patient cohort may be improved with patient and tumour-specific treatments.
PubMed: 31558978
DOI: 10.4251/wjgo.v11.i9.741 -
Journal of Thoracic Oncology : Official... Dec 2019Synchronous oligometastatic (sOM) disease is an oncological concept characterized by a limited cancer burden. Patients with oligometastasis could potentially benefit...
INTRODUCTION
Synchronous oligometastatic (sOM) disease is an oncological concept characterized by a limited cancer burden. Patients with oligometastasis could potentially benefit from local radical treatments. Despite the fact that the sOM condition is well recognized, a universal definition, including a specific definition for NSCLC, is not yet available. The aim of this systematic review was to summarize the definitions of and staging requirements for use of the term synchronous oligometastatic in the context of NSCLC.
METHODS
The key issue was formulated in one research question according to the population, intervention, comparator, and outcomes strategy. The question was introduced in MEDLINE (OvidSP). All articles dealing with sOM NSCLC and providing a definition of synchronous oligometastasis in NSCLC were selected and analyzed.
RESULTS
A total of 21 eligible articles focusing on sOM NSCLC were retrieved and analyzed. In 17 studies (81%), patients had to be staged with magnetic resonance imaging or computed tomography of the brain, thoracic and abdominal computed tomography, and positron emission tomography. The total number of metastases allowed in the definitions ranged from one to eight, but in 38.1% of studies the maximum number was 5. Most of the publications did not define the number of involved organs or the maximum number of metastases per organ. For mediastinal lymph node involvement, only five articles (27.8%) counted this as a metastatic site.
CONCLUSIONS
No uniform definition of sOM NSCLC could be retrieved by this systematic review. However, extended staging was mandated in most of the studies. An accepted oncological definition of synchronous oligometastasis is essential for patient selection to define prospective clinical trials.
Topics: Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Neoplasm Metastasis; Treatment Outcome
PubMed: 31195177
DOI: 10.1016/j.jtho.2019.05.037