Abstract
BackgroundConsensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. ObjectiveTo assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. Material and methodsEuropean expert centers (n = 49) were requested to discuss 15 real-life cases in their MDT with at least a medical, surgical, and radiation oncologist present. The cases varied in terms of location and number of metastases, histology, timing of detection (i.e. synchronous versus metachronous), primary tumour treatment status, and response to systemic therapy. The primary outcome was the agreement in the definition of oligometastatic disease at diagnosis and after systemic therapy. The secondary outcome was the agreement in treatment strategies. Treatment strategies for oligometastatic disease were categorised into upfront local treatment (i.e. metastasectomy or stereotactic radiotherapy), systemic therapy followed by restaging to consider local treatment or systemic therapy alone. The agreement across MDTs was scored to be either absent/poor (<50%), fair (50%–75%), or consensus (≥75%). ResultsA total of 47 MDTs across 16 countries fully discussed the cases (96%). Oligometastatic disease was considered in patients with 1–2 metastases in either the liver, lung, retroperitoneal lymph nodes, adrenal gland, soft tissue or bone (consensus). At follow-up, oligometastatic disease was considered after a median of 18 weeks of systemic therapy when no progression or progression in size only of the oligometastatic lesion(s) was seen (consensus). If at restaging after a median of 18 weeks of systemic therapy the number of lesions progressed, this was not considered as oligometastatic disease (fair agreement). There was no consensus on treatment strategies for oligometastatic disease. ConclusionA broad consensus on definitions of oligometastatic oesophagogastric cancer was found among MDTs of oesophagogastric cancer expert centres in Europe. However, high practice variability in treatment strategies exists.
Highlights
Oligometastatic disease is defined as an intermediate state between loco-regional and systemic disease and reflects a potentially distinct and favourable tumour biology [1]
This is the first study investigating the agreement in the definition and treatment of oligometastatic oesophagogastric cancer in European expert centers
Consensus (i.e. 75% agreement) across multidisciplinary tumour boards (MDTs) was reached that the term oligometastatic disease was appropriate across presented cases with oesophagogastric cancer with one or two metastases in either liver, lung, retroperitoneal lymph nodes, adrenal gland, soft tissue, or bone
Summary
Oligometastatic disease is defined as an intermediate state between loco-regional and systemic disease and reflects a potentially distinct and favourable tumour biology [1]. A recent randomised controlled trial (RCT) has shown improved OS after SBRT for oligometastatic prostate-, lung- or colorectal cancer as compared with systemic therapy alone or observation [2]. In patients with oesophagogastric cancer, RCTs for oligometastatic disease are ongoing [4], [e] [10] while non-randomised trials have suggested improved OS after local treatment for oligometastasis as compared with systemic therapy alone [11,12]. Objective: To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. The primary outcome was the agreement in the definition of oligometastatic disease at diagnosis and after systemic therapy. If at restaging after a median of 18 weeks of systemic therapy the number of lesions progressed, this was not considered as oligometastatic disease (fair agreement).
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