Surgeon's Perspective to Local Therapy in Oligometastatic Cancer
Oligometastatic cancer has been recognized as a distinct clinical entity for over 100 years. For decades surgeons have been devising strategies to identify patients with oligmetastatic cancer that have the potential to be cured by surgically removing the oligometastases (“curative intent metastasectomy”). More recently, several studies have suggested there may be benefits to local therapy in oligometastatic cancer patients that are less likely to be cured. This has transformed the practice of local therapy in this setting away from “curative intent” to a broader purpose of “lesion-specific cytoreduction.” As a ...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Oligometastatic Disease and Local Therapies: A Medical Oncology Perspective
This article reviews the literature in oligometastatic disease and considers a theoretical rationale for a curative approach in a subset of oligometastatic solid tumor patients. In oligometastatic colorectal cancer patients with liver-only metastases and in non–small cell lung cancer patients with disease control after primary therapy and with limited nodal involvement, aggressive local therapies should be considered. Clinical trials and further biomarker validation across disease types are necessary to clarify which subsets of patients may define a theorized “oligometastatic state” and therefore benefit from aggress...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Oligometastatic and Oligoprogression Disease and Local Therapies in Prostate Cancer
Our understanding of metastatic disease is rapidly advancing, with recent evidence supporting an oligometastatic state currently defined by patients having a limited (typically ≤5) number of metastatic deposits. The optimal management of these patients is also shifting toward increased integration of local therapies, with emerging evidence suggesting metastasis-directed therapy can improve overall survival. Additionally, the use of stereotactic ablative radiation therapy within castration-sensitive oligometastatic prostate cancer cohorts appears to forestall the need to initiate systemic therapy, which has unfavorable si...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Local Ablative Therapies for Oligometastatic and Oligoprogressive Non–Small Cell Lung Cancer
More than half of all patients with non–small cell lung cancer (NSCLC) have metastatic disease at the time of diagnosis. A subset of these patients has oligometastatic disease, which exists in an intermediary state between locoregional and disseminated metastatic disease. In addition, some metastatic patients on systemic therapy may have limited disease progression, or oligoprogression. Historically, treatment of metastatic NSCLC was palliative in nature, with little expectation of long-term survival. However, an accumulation of evidence over the past 3 decades now demonstrates that local ablative therapy to sites of lim...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Imaging and Image-Guided Thermal Ablation for Oligometastatic Colorectal Cancer Liver Disease
Colorectal cancer affects more than 1 million people worldwide, and half of this population develops liver metastases. Image-guided thermal ablation is an acceptable local therapy for the management of oligometastatic colorectal cancer liver disease, in patients who are noneligible for surgery, or present with recurrence after hepatectomy. Continuous technological evolutions, understanding of tumor variability through disease biology and genetics, and optimization of ablation parameters with ablation margin assessment have allowed patients with resectable small-volume disease to be treated by thermal ablation with curative...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Circulating Tumor DNA Biomarkers for Early Detection of Oligometastasis
Oligometastasis represents an intermediate disease stage between localized and widely metastatic cancer. Efficient identification of patients with oligometastasis remains a barrier for accrual on clinical trials of oligometastasis-directed therapy. Here we review the prospect of circulating tumor DNA–based monitoring to promote sensitive, specific, and cost-efficient detection of cancer recurrence during posttreatment surveillance. Thus, an impetus for the development and implementation of clinical-grade circulating tumor DNA assays should be for the positive impact they will have on clinical investigations of oligometas...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Radiomics, Radiogenomics, and Next-Generation Molecular Imaging to Augment Diagnosis of Hepatocellular Carcinoma
We present current imaging methods and explore emerging research that may improve diagnosis and monitoring of local, oligometastatic, and disseminated cancers exhibiting heterogeneous uptake of [18F]F-fluorodeoxyglucose, using hepatocellular carcinoma as an example. (Source: The Cancer Journal)
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Prognostic and Predictive Biomarkers in Oligometastatic Disease
Metastatic lesions are largely responsible for cancer-related deaths and are synonymous with a poor prognosis. However, this is not always true for patients with oligometastases whose disease may be amenable to curative-intent local therapies. It has been proposed that an “intermediate state” (oligometastasis) exists in between locoregional and advanced disease states; however, the clinical definition of oligometastasis varies, and there is limited understanding of how tumor biology differs between oligometastases and polymetastases. There is evidence that local therapies can extend survival in patients with oligometas...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Definition, Biology, and History of Oligometastatic and Oligoprogressive Disease
Historical theories of metastasis have been informed by the seed and soil hypothesis, the Halsteadian paradigm proposing an orderly spread from local to distant sites, and the presumption that cancer is an inherently systemic process even in the earliest cases. The more contemporary spectrum theory now suggests that the propensity for distant spread exists along a continuum of metastatic virulence. Tumors with limited metastatic potential represent one subset along this spectrum that could potentially be cured with local ablative therapy. Integrating clinical and molecular features to biologically inform the classification...
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Introduction by the Guest Editor: Oligometastatic Disease in Cancer
No abstract available (Source: The Cancer Journal)
Source: The Cancer Journal - March 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Radiotherapy in the Management of Metastatic Hormone-Sensitive Prostate Cancer: What Is the Standard of Care?
Systemic therapy has historically been the backbone of treatment for patients with metastatic disease. However, recent evidence suggests metastasis-directed therapy in those with oligometastatic disease (≤5 lesions) may improve progression-free and overall survival. Within prostate cancer–specific cohorts, metastasis-directed therapy also appears to delay the time to initiation of androgen deprivation therapy while also generally being associated with a mild toxicity profile and has thus garnered interest as a means to delay systemic therapy. Here we review the evidence surrounding the use of radiation therapy to metas...
Source: The Cancer Journal - January 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Treatment of Primary in Metastatic Prostate Cancer: What Is the Standard of Care?
Until recently, men with metastatic prostate cancer were commenced on androgen deprivation therapy at diagnosis, followed by sequential lines of treatment with the development of castration resistance. However, the results of recent clinical trials, which revealed that the addition of radiotherapy to the prostate to a dose of 55 to 60 Gy in 20 fractions over 4 weeks in patients with low-volume metastatic hormone-sensitive prostate cancer, in addition to androgen deprivation therapy and another systemic treatment option, either docetaxel, abiraterone, enzalutamide, or apalutamide, has led to a paradigm change in the managem...
Source: The Cancer Journal - January 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Factors to Guide Treatment Selection for Hormone-Sensitive Metastatic Prostate Cancer
For decades, the mainstay of treatment for metastatic hormone-sensitive prostate cancer has been androgen deprivation therapy. In recent years, 4 systemic therapies—docetaxel, abiraterone, enzalutamide, and apalutamide—have improved overall survival for men with metastatic hormone-sensitive prostate cancer when combined with androgen deprivation therapy, raising the question of which treatment to choose. The role for metastasis-directed therapy with surgery or radiation among these new treatments has also yet to be defined. Thus, several factors have come into play to guide treatment selection, including disease charac...
Source: The Cancer Journal - January 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Metastatic Hormone-Sensitive Prostate Cancer: A Review of the Current Treatment Landscape
We describe an overview of the trials that investigated docetaxel (CHAARTED and STAMPEDE-Docetaxel), abiraterone (LATTITUDE and STAMPEDE-Abiraterone), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN), and radiation to the primary (STAMPEDE-Radiation).
Discussion
The treatment of mHSPC is a complex topic, and treatment choice should be individualized. Patient preferences, cost, volume of disease, and side effect profiles are important in determining which option is the best for an individual patient. (Source: The Cancer Journal)
Source: The Cancer Journal - January 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Pathologically Node-Positive Prostate Cancer: Casting for Cure When the Die Is Cast?
The postoperative management of men with lymph node involved prostate cancer (pN+) remains a challenge as there is a general lack of randomized trial data and a range of management strategies. Retrospective studies suggest a variable clinic course for patients with pN+ prostate cancer. Some men progress rapidly to metastatic disease despite further therapies, whereas other men can have a period of prolonged quiescence without adjuvant androgen deprivation therapy (ADT) or radiation therapy (RT). For men who have undergone radical prostatectomy, randomized trial data indicate that the addition of ADT in pN+ disease extends ...
Source: The Cancer Journal - January 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
