Oligometastatic Disease Research Articles (Page 1)

Paraspinal involvement has been consistently reported as a negative predictor of local control following stereotactic body radiation therapy (SBRT) for spinal metastases. The aim of this study was to investigate the characteristics of paraspinal disease and determine the impact on outcomes. Patients who underwent SBRT for spinal metastases with paraspinal involvement, identified from a single-institutional prospective database, were retrospectively reviewed. Those with prior radiation therapy/surgery were excluded. The treated clinical target volume (CTV) was segmented into paraspinal (CTV_PS), neuroforaminal (CTV_NF), epidural (CTV_EP), and osseous bone (CTV_bone) components. The extent of extraosseous disease was classified according to the involvement of rib, neuroforamina, and muscle. Volume and dosimetric parameters were collected and dichotomized using recursive binary partitioning. The outcomes of interest were the cumulative incidence of local failure (LF), overall survival (OS), and reirradiation rates. One hundred fourteen patients with 125 treated spinal sites were identified. There were 38% (47/125), 66% (82/125), and 19% (24/125) treated spinal sites with involvement of rib, neuroforamina, and muscle, respectively. The median follow-up duration of the cohort was 17.34 months (IQR 7.79-40.11 months). The 12-month and 24-month cumulative incidence rates of LF were 19.5% (95% CI 12.6%-27.4%) and 29.8% (95% CI 21.4%-38.7%), respectively. The 12-month cumulative incidence rates of LF were 12.0% (95% CI 5.9%-20.5%) and 36.3% (95% CI 20.2%-52.6%) for patients with CTV_PS < 42.9 mL and those with ≥ 42.9 mL (p < 0.001), respectively, and 55.6% (95% CI 28.7%-75.8%) and 12.2% (95% CI 6.5%-19.9%) for patients with and without muscle invasion (p = 0.001), respectively. In the multivariable analysis, only CTV_PS remained statistically associated with LF. CTV_PS ≥ 42.9 mL was associated with 2.3 times (95% CI 1.13-4.83, p = 0.02) increased risk of LF compared with CTV_PS < 42.9 mL. The 12-month and 24-month OS rates were 56% (95% CI 47%-65%) and 41% (95% CI 32%-50%), respectively. Patients with an Eastern Cooperative Oncology Group performance status score < 1 and oligometastatic disease (≤ 5 metastases) were associated with better OS in the multivariable analysis. The 12-month and 24-month reirradiation rates were 7.3% (95% CI 3.4%-13.3%) and 16.5% (95% CI 10.2%-24.1%), respectively. Spinal metastases with high-volume paraspinal involvement were associated with increased risk of LF following SBRT, and strategies to optimize local control are required.

The study evaluated the real-world outcomes of the pertuzumab/docetaxel/carboplatin/trastuzumab (PTCH) regimen in Indian patients with human epidermal growth factor receptor 2-positive (HER2+) early, locally advanced, and oligometastatic breast cancer (BC). Data from patients treated with neoadjuvant PTCH between January 2015 and December 2024 were retrospectively reviewed. The primary end point was the pathologic complete response (pCR) rate, with secondary end points including disease-free survival (DFS) and toxicity. Kaplan-Meier analysis assessed survival; Cox regression and logistic regression were used for multivariate analyses. A total of 152 patients were included (median age: 47 years; range: 23-72 years): 45 patients (29.6%) had stage II, 89 (58.55%) had stage III, and 18 (11.84%) had oligometastatic disease. Overall, 68 (44.7%) patients had hormone receptor-positive disease, and 94 (61.8%) were premenopausal. The overall pCR rate was 83 (54.6%). The pCR rate of the hormone receptor-negative group (68%) was higher than that of the hormone receptor-positive group (45.1%). With a median follow-up of 33 months, the 3-year DFS was 47.5%, 58% in patients who achieved pCR, and 33.5% in those who did not achieve pCR (P = .001). The most common adverse events (grade 3/4) were diarrhea (17.1%) and thrombocytopenia (7.8%). In the multivariate analyses, lower odds of achieving pCR were associated with recurrence (odds ratio, 0.383, P = .018). An improved DFS was observed in the age group of 31-45 years. The PTCH regimen demonstrated efficacy and a tolerable safety profile in patients with HER2+ BC in an Indian real-world setting. Achieving pCR is a significant predictor of improved DFS. The PTCH regimen obviates the need for adjuvant trastuzumab emtansine after surgery, making it a cost-effective strategy in a limited-resource setting.

Clinical Evaluation of Stereotactic Ablative Radiotherapy for Oligometastases From Rare Primary Cancers.

Carbon ion therapy for pancreatic cancer with risk-adapted dose escalation: initial clinical experience.

To evaluate the survival outcomes of breast cancer patients with metastatic bone disease and to assess whether these patients exhibit different prognoses compared to those with more extensive metastatic involvement. Systemic therapy including endocrine therapy, chemotherapy and targeted agents remains the cornerstone of treatment for patients with stage IV breast cancer, particularly those with bone metastases. Palliative radiotherapy also plays a key role in bone metastases, especially for symptom control and managing skeletal and complications. Although these modalities have significantly improved outcomes, the prognostic variation among patients with bone-only disease-ranging from solitary to widespread metastases-warrants further investigation. This study aims to evaluate survival outcomes among breast cancer patients with varying patterns of bone metastases. This retrospective cohort study analyzed data from 4000 breast cancer patients treated between 2006 and 2024. Patients were evaluated for bone metastases, which were confirmed through imaging reviewed via the Picture Archiving and Communication System (PACS). Patients with confirmed bone metastases were categorized into solitary, oligometastatic (2-5 sites), or multiple metastases groups. Data on demographics, tumor characteristics, treatment regimens, surgery types, and survival outcomes were collected. Survival analyses were conducted using Kaplan-Meier curves and compared using log-rank tests. One hundred and eighty-seven patients with metastatic bone disease were identified. 21 patients had solitary bone metastases only with a mean survival of 14.6years. Additionally, 30 patients had oligometastatic bone disease only with a mean survival of 7years. Another 31 patients had multiple bone only metastases, with also a mean survival of 7years. Finally, 105 of the 187 patients had other metastases alongside bone metastases in other organs including the lung, liver, and brain with a mean survival of 6.3years. These findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard these findings suggest that patients with bone-only metastases, particularly those with solitary lesions, exhibit significantly longer survival. Although systemic therapy remains the standard, these findings highlight the need for further research into whether selected patients may benefit from integrating local treatment approaches, including surgery, into their management.

The specific risk factors for surgical site infection (SSI) in orthopaedic oncology patients undergoing endoprosthetic reconstruction have not previously been evaluated in a large prospective cohort. The current study aims to define patient and procedure-specific risk factors for SSI in patients undergoing surgical excision and endoprosthetic reconstruction of the lower extremity for oncologic indications using the prospectively collected data of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. PARITY was a multicenter, blinded, parallel two-arm design randomized controlled trial that aimed to determine the effect of long (5 days) vs. short duration (24 hours) postoperative prophylactic antibiotics on the rate of SSI in patients undergoing surgical excision of the femur or tibia. The primary analysis of the PARITY study of 604 eligible patients was published in the Journal of the American Medical Association (Oncology) on January 6, 2022. In this secondary analysis of the PARITY data, a multivariate Cox proportional hazards regression model was constructed to explore predictors of SSI within one year postoperatively. Based on the outcomes of the univariate analysis and theoretical relationships, the following variables were selected for inclusion in the regression model: age, sex, tumor location (femur vs. tibia) and type (primary bone vs. soft tissue sarcoma invading bone vs. oligometastatic bone disease), soft tissue mass, preoperative neutropenia, neoadjuvant chemotherapy, operative time, total muscle excised, intraoperative vancomycin powder use, silver coated prosthesis, prosthesis betadine soak, arthroplasty helmet use, operative laminar flow, postoperative suction drain, urinary catheter, postoperative negative pressure wound therapy, hospital length of stay (LOS) and adjuvant chemotherapy. The results of the model are presented with hazards ratios (HR) and 95% confidence intervals (CI). A total of 96 of 604 patients (15.9%) experienced an SSI. Of the 22 variables analysed in the univariate analysis, four variables achieved statistical significance: tumor type, operative time, volume of muscle excised and hospital LOS. However, only hospital LOS was found to be independently predictive of SSI in the multivariate regression analysis (HR = 1.03, 95% CI = [1.01–1.05], P = 0.001). An omnibus test of model coefficients demonstrated that the model showed significant improvement over the null model (χ2 = 76.6, P 0.7 as a cut off for exclusion. This secondary analysis of the PARITY study data found that among the potential risk factors for SSI following endoprosthetic reconstruction of the lower extremity, the only independent risk factor on multivariate analysis was hospital LOS. It therefore may be reasonable for clinicians to consider streamlined discharge plans for orthopaedic oncology patients to potentially reduce the risk for SSI.

Metastatic disease traditionally classifies gastric cancer as stage M1, precluding surgical intervention and enrolling patients in palliative treatment protocols. This principle holds regardless of the number, the location, and the quantity of metastatic sites. "Oligometastatic disease" is an intermediate state between localized and widely spread gastric cancer. Locoregional treatments may offer long survival or even cure in highly selected cases. There are no evidence-based guidelines for the appropriate management of this clinical entity. Tailored strategic techniques are required to incorporate surgical treatment, when applicable, into the management protocols of these patients. The surgical approach (following neoadjuvant treatment) aiming at R0 resection of neoplasms that are technically or oncologically unresectable, or only borderline resectable at initial evaluation is defined as "conversion therapy". The surgical approach aims at locoregional control of the disease, radical resection of all cancer sites, adequate lymph node cleansing and uncomplicated anastomosis. Disease progression is a clear indication of palliative treatment. In this article, we aim to provide an extensive literature search about current status of oligometastatic gastric disease multimodal treatment. Given the malignancy potential of gastric cancer, the decision for an operative approach should be made with strict criteria by experienced surgeons and rational oncologists.

Next-generation imaging (NGI) (68Ga-prostate-specific membrane antigen (PSMA)-PET) represents a cornerstone in biochemical recurrent prostate cancer management. PSICHE is a multicentric prospective study, aimed to assess oncological outcomes of a predefined tailored imaging-guided treatment. Patients with biochemical recurrence (BCR) after surgery (prostate-specific antigen [PSA] > 0.2 ≤ 1ng/mL) underwent staging with PSMA-PET. A predefined treatment algorithm was proposed to all patients: prostate bed salvage radiotherapy (SRT) in case of negative or positive PET within the prostate bed, stereotactic body radiotherapy (SBRT) if pelvic nodal recurrences or oligometastatic disease were detected, and androgen deprivation therapy (ADT) was proposed in widespread polymetastatic disease. Chi-square test was used to evaluate the relationship between baseline features and the rate of positive PSMA-PET/CT. One hundred and fifty-nine patients were enrolled. One hundred and seven patients had a PSMA negative/positive in the prostate bed; pelvic nodal disease or oligometastatic metastatic disease was detected in 39 and 10 patients, respectively. Three patients had a polymetastatic disease. Seventeen patients underwent observation because of prior postoperative radiotherapy (RT)/treatment refusal. Eighty-eight patients were treated with SRT, and SBRT was performed in 49 patients with pelvic or extrapelvic oligometastatic disease. Stratifying patients according to EAU criteria (low risk: PSA doubling time > 12months and Gleason score < 8; high risk: PSA doubling time ≤ 12months or Gleason score ≥ 8) after a median follow-up of 19months in the overall population, median BRFS and MFS were not significantly different between the two risk subgroups (p = 0.58 and p = 0.21, respectively). Median metastasis-free and ADT-free survival were not reached. A PSMA-targeted treatment strategy led to promising results, avoiding unnecessary toxicity from ADT or standard SRT administered in unselected patients. Analysis after longer follow-up is needed to clarify survival outcomes.

Objective: We evaluated a cohort of patients with liver metastasis from uveal melanoma (LMUM) to assess the benefit of intensive surveillance and multimodal treatment on overall survival. Background: LMUM is typically associated with a poor prognosis. Patients and methods: This two-center retrospective cohort study from January 2010 to December 2024 included 58 patients with LMUM deemed to be oligometastatic and referred for surgical management. Overall survival after treatment of LMUM and primary uveal melanoma was determined using Kaplan–Meier methods and the Cox proportional hazards method. Results: Fifty-eight patients [performance status (PS): PS1 = 11, PS0 = 47] with oligometastatic LMUM were screened to stratify patients with multifocal disease not undergoing liver surgical/ablative treatment (Group A, n = 27) and those with oligometastatic liver disease having liver resection/ablation (Group B, n = 31) along with systemic treatment as per patient/physician choice. Patients in Group B had longer liver-specific overall survival [Group B: OS = 45.1 (95% confidence interval (CI) = 33.5–not reached] months; Group A, median 18.6 (95% CI = 13.8–23.8) months; P &lt; 0.0001, log-rank (Mantel-Cox) test, hazard ratio (HR): 0.13, 95% CI = 0.06–0.28) and better overall survival from initial treatment for primary uveal melanoma [Group B 14.1 (95% CI = 8.2–20.8) years vs Group A 3.6 (95% CI = 2.5–5.5) years; P &lt; 0.0001, HR: 0.24, (95% CI = 0.11–0.50)]. Conclusions: Intensive surveillance for early diagnosis of oligometastatic LMUM and its relapse along with surgical resection/ablation and systemic treatment facilitates long-term remission. This retrospective case series requires prospective validation in a multicenter cohort study.

Locoregional treatment of esophageal oligometastatic disease to the liver: single center experience, a systematic review and meta-analysis.

Pretracheal (No.106pre) lymph node metastasis in esophageal carcinoma: A sign of widespread disease progression, but potentially treatable as oligometastatic disease through neoadjuvant chemotherapy followed by surgery - A multicenter cohort study.

Multinational validation of distant metastasis velocity as a post-progression prognostic score in patients with oligometastatic cancer treated with metastasis-directed stereotactic body radiotherapy.

Metastasis-directed radiotherapy without systemic therapy for oligometastatic clear-cell renal-cell carcinoma: primary efficacy analysis of a single-arm, single-centre, phase 2 trial.

Oligometastatic and Oligoprogressive Disease in Lung Cancer: Concepts for Radiologists.

To assess the clinical outcomes and evaluate Freedom from Introduction or Switching of Systemic Treatment (FISST) in patients with oligometastatic (OM) and oligoprogressive (OP) disease undergoing stereotactic body radiotherapy (SBRT). The primary end points were FISST and local control (LC) rates of lesions that received SBRT. The secondary end point was overall survival (OS) after SBRT. To calculate FISST, event was defined as the need to introduce or switch the systemic line of treatment for any reason or inability to provide systemic treatment when needed because of poor performance status (PS) (Eastern Cooperative Oncology Group PS ≥3) or other reasons. OS was a secondary outcome. A total of 200 patients were included. The median age was 60 (IQR, 49-70) years. The most common primary tumors were colorectal (61, 30.5%), breast (30, 15.0%), lung (28, 14.0%), head and neck (23, 11.5%), and prostate (16, 8.0%). A total of 257 metastatic lesions were treated. Bone was the most frequent site (115, 44.7%), followed by the liver (55, 21.4%), lung (44, 17.1%), lymph nodes (25, 9.7%), and adrenal glands (11, 4.3%). The median follow-up was 15 months. FISST at 1 and 2 years were 52% and 39%, respectively. LC at 1 and 2 years were 86.3% and 80%, respectively. OS at 1 and 2 years were 76.5% and 64.8%, respectively. Grade III toxicity was reported in 1.5% of patients overall, with no observed grade IV or V toxicity. SBRT is effective and safe for treating OM and OP solid cancers, prolonging FISST and potentially delaying systemic treatments, particularly in settings with limited access to advanced therapies.

Complete mesocolic excision in radical colorectal cancer surgery enhances both surgical quality and the accuracy of pathological staging. In the context of sigmoid colon cancer, the optimal extent of lymphadenectomy and the appropriate level of vascular ligation remain controversial. High ligation of the inferior mesenteric artery may facilitate more thorough lymph node dissection and allow for tension-free anastomosis. However, it requires a comprehensive assessment of postoperative complication risks and the preservation of organ function. Para-aortic lymph node dissection has shown potential survival benefits in patients with oligometastatic disease, yet its application should be individualized. Moreover, intraoperative navigation technologies, such as indocyanine green fluorescence imaging, can assist in accurately delineating the dissection field and support the feasibility of personalized surgical strategies. This review synthesizes current evidence and leading domestic and international clinical guidelines to systematically examine the latest developments in lymphadenectomy strategies for sigmoid colon cancer, focusing on mesenteric anatomy, D3 dissection, complete mesocolic excision, vascular ligation levels, para-aortic lymph node dissection, and fluorescence-guided imaging techniques.

Extraskeletal mesenchymal chondrosarcoma: oligometastatic disease and effect of multimodal treatment

Durvalumab Combined With Chemotherapy and SABR Therapy in Patients With Oligometastatic Non-small Cell Lung Cancer: A Multicenter Phase 2 Study.

Spatially fractionated radiotherapy for re-irradiation: feasibility, safety, treatment planning, and outcomes☆

Current standards of clinical practice recommend systemic chemotherapy but no surgical approach for Stage IV pancreatic ductal adenocarcinoma (PDAC), with expected overall median survival between 3 and 6months. In the last 20years, a subset of patients with a limited number of metastases to just one or two organs (liver and/or lungs) and a less aggressive biology and growth ability have been identified and defined as "oligometastases" (OM). The continuous improvement in systemic therapy with the arrival of the multiagent FOLFIRINOX and gemcitabine + nab-paclitaxel and the refinements and advances in surgical techniques have shifted the focus from technical resectability to biological treatment for patients with OM from PDAC. In this review we evaluate the existing evidence for metastasectomy in the liver, lungs, interaortocaval lymph nodes and peritoneum, assessing the potential indications for surgery and contributing with some general rules that can be followed.