Approach of oligometastatic cancer with intent of cure- exploring the road to recovery: interim analysis

Authors

DOI:

https://doi.org/10.18203/2349-2902.isj20240174

Keywords:

Oligometastasis, Oligometastases, Oligometastatic cancer, Oligometastatic breast cancer, Metastatic cancer

Abstract

Oligometastases is a disease concept that is a state of limited systemic metastatic tumors defined in most studies as 1-3 or 1-5 metastatic lesions for which local therapy could be curative. Oligometastatic cancer has been traditionally managed by systemic therapy. With the hypothesis that not only long-term disease control, but also cure can be achieved in at least in a proportion of such patients, we analysed whether aggressive multimodality approach could become a new standard of care in highly selected patients with oligometastatic cancer. It is a case series of potentially curable oligometastatic cancers in our Institution approached with cure directed ablative/surgical procedures. An interim analysis was done after completion of all modalities of treatment and the outcomes analysed were local control/cure and disease-free survival. 15 patients were treated with curative intent which included eleven breast cancer and one each of gastric, OG junction, oesophagus, and rectal cancer. Metastases were treated with surgery in seven patients. Four patients were treated with SBRT, and EBRT was used in three other patients to treat metastases. Three patients had complete resolution of metastasis after chemotherapy. Disease-free/progression-free survival were compared with real world data where metastatic disease was treated with non-curative intent. The DFS/PFS for breast, gastric/oesophageal, and rectal cancer were 18.4 verses 6-13.3 months, 10.5 verses 5.6 months, and 15 verses 9.6 months respectively. Approaching oligometastasis with an intent of cure has shown to achieve reasonable local control/cure in our study and improve the DFS/PFS on comparison with real world data.

References

Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget. 2015;6(11):8491-524.

Palma DA, Salama JK, Lo SS, Senan S, Treasure T, Govindan R, Weichselbaum R. The oligometastatic state - separating truth from wishful thinking. Nat Rev Clin Oncol. 2014;11(9):549-57.

Courtinard C, Gourgou S, Jacot W, Carton M, Guérin O, Vacher L, et al. Association between progression-free survival and overall survival in women receiving first-line treatment for metastatic breast cancer: evidence from the ESME real-world database. BMC Med. 2023;21(1):87.

Kimura A, Sakai D, Kudo T. The real-world data in patients with advanced gastric cancer treated with ramucirumab combination chemotherapy. J Clin Oncol. 37(4):156.

Pericay C, Gallego J, Fernandez Montes A. Real world data in colorectal cancer: A retrospective analysis of overall survival in metastatic colorectal cancer patients between 2011-2015 treated in Spain, preliminary results (RWD-ACROSS study). Ann Oncol. 2018;29.

Milano MT, Biswas T, Simone CB 2nd, Lo SS. Oligometastases: history of a hypothesis. Ann Palliat Med. 2021;10(5):5923-30.

Rao A, Vapiwala N, Schaeffer EM, Ryan CJ. Oligometastatic Prostate Cancer: A Shrinking Subset or an Opportunity for Cure? Am Soc Clin Oncol Educ Book. 2019;39:309-20.

Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, et al. Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2018;4(1):e173501.

Sperduto PW, Shanley R, Luo X, Andrews D, Werner-Wasik M, Valicenti R, et al. Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA). Int J Radiat Oncol Biol Phys. 2014;90(3):526-31.

Lievens Y, Guckenberger M, Gomez D, Hoyer M, Iyengar P, Kindts I, et al. Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document. Radiother Oncol. 2020;148:157-66.

Guckenberger M, Lievens Y, Bouma AB, Collette L, Dekker A, deSouza NM, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020;21(1):e18-e28.

Zhang L, Wang XZ, Li C, Yu Q, Liu Z, Yu ZY. Contralateral Axillary Lymph Node Metastasis of Breast Cancer: Retrospective Analysis and Literature Review. Front Oncol. 2022;12:869397.

Makhlin I, Fox K. Oligometastatic Breast Cancer: Is This a Curable Entity? A Contemporary Review of the Literature. Curr Oncol Rep. 2020;22(2):15.

Nagasaki E, Kudo R, Tamura M, Hayashi K, Uwagawa T, Kijima Y, et al. Long-term outcomes of oligometastatic breast cancer patients treated with curative intent: an updated report. Breast Cancer. 2021;28(5):1051-61.

Badwe R, Hawaldar R, Nair N, Kaushik R, Parmar V, Siddique S, et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol. 2015;16(13):1380-8.

Chmura SJ, Winter KA, Woodward WA, Borges VF, Salama JK. NRG-BR002: A phase IIR/III trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer (NCT02364557). 2022;16(7):1007.

Salati M, Valeri N, Spallanzani A, Braconi C, Cascinu S. Oligometastatic gastric cancer: An emerging clinical entity with distinct therapeutic implications. Eur J Surg Oncol. 2019;45(8):1479-82.

Markar SR, Mackenzie H, Mikhail S, Mughal M, Preston SR, Maynard ND, et al. Surgical resection of hepatic metastases from gastric cancer: outcomes from national series in England. Gastric Cancer. 2017;20(2):379-86.

Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, et al. Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212): A Multicenter, Randomized Controlled, Noninferiority Trial. Ann Surg. 2017;266(2):201-7.

Kim MJ, Oh JH. Lateral Lymph Node Dissection With the Focus on Indications, Functional Outcomes, and Minimally Invasive Surgery. Ann Coloproctol. 2018;34(5):229-33.

Zhou S, Jiang Y, Pei W, Liang J, Zhou Z. Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis. BMC Surg. 2021;21(1):441.

Treasure T, Farewell V, Macbeth F, Monson K, Williams NR, Brew-Graves C, et al. Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): a multicentre randomised clinical trial. Trials. 2019;20(1):718.

Ruers T, Punt C, Van Coevorden F, Pierie JPEN, Borel-Rinkes I, Ledermann JA, et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC 40004). Ann Oncol. 2012;23(10):2619-26.

Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363(9422):1665-72.

Kayama T, Sato S, Sakurada K, Mizusawa J, Nishikawa R, Narita Y, et al. Effects of Surgery With Salvage Stereotactic Radiosurgery Versus Surgery With Whole-Brain Radiation Therapy in Patients With One to Four Brain Metastases (JCOG0504): A Phase III, Noninferiority, Randomized Controlled Trial. J Clin Oncol. 2018:JCO2018786186.

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Published

2024-01-30

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Case Series