TY - JOUR
T1 - Definition of oligometastatic esophagogastric cancer and impact of local oligometastasis-directed treatment
T2 - A systematic review and meta-analysis
AU - Kroese, Tiuri E.
AU - van Laarhoven, Hanneke W. M.
AU - Nilsson, Magnus
AU - Lordick, Florian
AU - Guckenberger, Matthias
AU - Ruurda, Jelle P.
AU - D'Ugo, Domenico
AU - Haustermans, Karin
AU - van Cutsem, Eric
AU - van Hillegersberg, Richard
AU - van Rossum, Peter S. N.
N1 - Publisher Copyright: © 2022 The Author(s)
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival (OS). The primary aim was to identify definitions of esophagogastric OMD. A secondary aim was to perform a meta-analysis of OS after local treatment versus systemic therapy alone for OMD. Methods: Studies and study protocols reporting on definitions or OS after local treatment for esophagogastric OMD were included. The primary outcome was the maximum number of organs/lesions considered OMD and the maximum number of lesions per organ (i.e. 'organ-specific' OMD burden). Agreement was considered to be either absent/poor (< 50%), fair (50%–75%), or consensus (≥ 75%). The secondary outcome was the pooled adjusted hazard ratio (aHR) for OS after local treatment versus systemic therapy alone. The ROBINS tool was used for quality assessment. Results: A total of 97 studies, including 7 study protocols, and 2 prospective studies, were included. OMD was considered in 1 organ with ≤ 3 metastases (consensus). 'Organ-specific' OMD burden could involve bilobar ≤ 3 liver metastases, unilateral ≤ 2 lung metastases, 1 extra-regional lymph node station, ≤ 2 brain metastases, or bilateral adrenal gland metastases (consensus). Local treatment for OMD was associated with improved OS compared with systemic therapy alone based on 6 non-randomized studies (pooled aHR 0.47, 95% CI: 0.30–0.74) and for liver oligometastases based on 5 non-randomized studies (pooled aHR 0.39, 95% CI: 0.22–0.59). All studies scored serious risk of bias. Conclusions: Current literature considers esophagogastric cancer spread limited to 1 organ with ≤ 3 metastases or 1 extra-regional lymph node station to be OMD. Local treatment for OMD appeared associated with improved OS compared with systemic therapy alone. Prospective randomized trials are warranted.
AB - Background: Local treatment (metastasectomy or stereotactic radiotherapy) for oligometastatic disease (OMD) in patients with esophagogastric cancer may improve overall survival (OS). The primary aim was to identify definitions of esophagogastric OMD. A secondary aim was to perform a meta-analysis of OS after local treatment versus systemic therapy alone for OMD. Methods: Studies and study protocols reporting on definitions or OS after local treatment for esophagogastric OMD were included. The primary outcome was the maximum number of organs/lesions considered OMD and the maximum number of lesions per organ (i.e. 'organ-specific' OMD burden). Agreement was considered to be either absent/poor (< 50%), fair (50%–75%), or consensus (≥ 75%). The secondary outcome was the pooled adjusted hazard ratio (aHR) for OS after local treatment versus systemic therapy alone. The ROBINS tool was used for quality assessment. Results: A total of 97 studies, including 7 study protocols, and 2 prospective studies, were included. OMD was considered in 1 organ with ≤ 3 metastases (consensus). 'Organ-specific' OMD burden could involve bilobar ≤ 3 liver metastases, unilateral ≤ 2 lung metastases, 1 extra-regional lymph node station, ≤ 2 brain metastases, or bilateral adrenal gland metastases (consensus). Local treatment for OMD was associated with improved OS compared with systemic therapy alone based on 6 non-randomized studies (pooled aHR 0.47, 95% CI: 0.30–0.74) and for liver oligometastases based on 5 non-randomized studies (pooled aHR 0.39, 95% CI: 0.22–0.59). All studies scored serious risk of bias. Conclusions: Current literature considers esophagogastric cancer spread limited to 1 organ with ≤ 3 metastases or 1 extra-regional lymph node station to be OMD. Local treatment for OMD appeared associated with improved OS compared with systemic therapy alone. Prospective randomized trials are warranted.
KW - Esophageal neoplasms
KW - Lymphatic metastasis
KW - Neoplasm metastasis
KW - Stomach neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85126942307&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejca.2022.02.018
DO - https://doi.org/10.1016/j.ejca.2022.02.018
M3 - Review article
C2 - 35339868
SN - 0959-8049
VL - 166
SP - 254
EP - 269
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -