Tiuri E Kroese1, Richard van Hillegersberg2, Sebastian Schoppmann3, Pieter R A J Deseyne4, Philippe Nafteux5, Radka Obermannova6, Marianne Nordsmark7, Per Pfeiffer8, Maria A Hawkins9, Elizabeth Smyth10, Sheraz Markar11, George B Hanna11, Edward Cheong12, Asif Chaudry13, Anneli Elme14, Antoine Adenis15, Guillaume Piessen16, Cihan Gani17, Christiane J Bruns18, Markus Moehler19, Theodore Liakakos20, John Reynolds21, Alessio Morganti22, Riccardo Rosati23, Carlo Castoro24, Domenico D'Ugo25, Franco Roviello26, Maria Bencivenga27, Giovanni de Manzoni27, Paul Jeene28, Johanna W van Sandick29, Christel Muijs30, Marije Slingerland31, Grard Nieuwenhuijzen32, Bas Wijnhoven33, Laurens V Beerepoot34, Piotr Kolodziejczyk35, Wojciech P Polkowski36, Maria Alsina37, Manuel Pera38, Tania F Kanonnikoff39, Magnus Nilsson40, Matthias Guckenberger41, Stefan Monig42, Dorethea Wagner43, Lucjan Wyrwicz44, Maaike Berbee45, Ines Gockel46, Florian Lordick47, Ewen A Griffiths48, Marcel Verheij49, Peter S N van Rossum50, Hanneke W M van Laarhoven51. 1. Department of Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 2. Department of Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands. 3. Department of Surgery, Medical University of Vienna, Vienna University, Vienna, Austria. 4. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 5. Department of Surgery, KU Leuven, Leuven University, Leuven, Belgium. 6. Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic. 7. Department of Radiation Oncology, Aarhus University Medical Center, Aarhus University, Aarhus, Denmark. 8. Department of Medical Oncology, Odense University Medical Center, University of Odense, Odense, Denmark. 9. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom. 10. Department of Oncology, Cambridge University Hospitals, Cambridge University, Cambridge, United Kingdom. 11. Department of Surgery, Imperial College London, London University, London, United Kingdom. 12. Department of Upper GI Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom. 13. Department of Surgery, Royal Marsden Hospital, London University, London, United Kingdom. 14. Department of Medical Oncology, Tallinn University Hospital, Tallinn University, Tallinn, Estonia. 15. Department of Medical Oncology, Institute Du Cancer de Montpellier Val D'Aurelle, Lille University, Lille, France. 16. Department of Surgery, University Hospital C. Huriez, Lille University, Lille, France. 17. Department of Radiation Oncology, University Hospital Tubingen, University of Tubingen, Tubingen, Germany. 18. Department of Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany. 19. Department of Medicine, Johannes Gutenberg-University Clinic, University of Mainz, Mainz, Germany. 20. Department of Surgery, University of Athens Medical School, University of Athens, Athens, Greece. 21. Department of Surgery, St. James Hospital, Trinity College Dublin, Dublin, Ireland. 22. Department of Radiation Oncology, University Hospital Bologna, Bologna, Italy. 23. Department of Surgery, San Raffaele Hospital, San Raffaele Vita-salute University, Milan, Italy. 24. Department of Surgery, Humanitas University Medical Center, Humanitas University, Milan, Italy. 25. Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. 26. Department of Surgery, Siena University Hospital, University of Siena, Siena, Italy. 27. Department of Surgery, University Hospital Verona, University of Vero, Verona, Italy. 28. Department of Radiation Oncology, Radiotherapy, Amsterdam University Medical Centers, Amsterdam, the Netherlands. 29. Department of Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands. 30. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 31. Department of Medical Oncology, University Medical Center Leiden, University of Leiden, Leiden, the Netherlands. 32. Department of Surgery, Catharina Medical Center, Eindhoven, the Netherlands. 33. Department of Surgery, Erasmus University Medical Center, University of Rotterdam, Rotterdam, the Netherlands. 34. Department of Medical Oncology, Elisabeth Tweesteden Ziekenhuis Tilburg, the Netherlands. 35. Department of Surgery, Jagiellonian University Medical College, Krakow, Poland. 36. Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland. 37. Department of Medical Oncology, Hospital Universitari Vall D'Hebron and Vall D'Hebron Institute of Oncology (VHIO), Barcelona, Spain. 38. Department of Surgery, Hospital Universitario Del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain. 39. Department of Medical Oncology, Hospital Clínico Universitario de Valencia, University of Valencia, Valancia, Spain. 40. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden. 41. Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 42. Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. 43. Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. 44. Department of Oncology and Radiotherapy, Maria Skłodowska-Curie Institute - Oncology Center, Warsaw, Poland. 45. Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands. 46. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany. 47. Department of Medical Oncology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany. 48. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 49. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 50. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 51. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: H.vanLaarhoven@amsterdamumc.nl.
Abstract
BACKGROUND: Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. OBJECTIVE: To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. MATERIAL AND METHODS: European 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%). RESULTS: A 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. CONCLUSION: A 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.
BACKGROUND: Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. OBJECTIVE: To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. MATERIAL AND METHODS: European 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%). RESULTS: A 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. CONCLUSION: A 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.
Authors: Tiuri E Kroese; Peter S N van Rossum; Sylvia van der Horst; Stella Mook; Nadia Haj Mohammad; Jelle P Ruurda; Richard van Hillegersberg Journal: Int J Surg Case Rep Date: 2022-07-19
Authors: Tiuri E Kroese; Nikita K N Jorritsma; Hanneke W M van Laarhoven; Rob H A Verhoeven; Stella Mook; Nadia Haj Mohammad; Jelle P Ruurda; Peter S N van Rossum; Richard van Hillegersberg Journal: Clin Transl Radiat Oncol Date: 2022-08-24