How would you approach oligometastatic (solitary) recurrence with previously resected pancreatic adenocarcinoma and adjuvant chemotherapy with a prolonged disease-free interval?

This is very different from colon cancer with a solitary recurrence after a long disease-free interval. In this case, before considering any local therapy, I would treat with a course of systemic therapy to establish favorable disease biology. The vast majority of patients with recurrent, oligometastatic pancreatic cancer will ultimately not be good candidates for local therapy. That being said, if there is no progression after 4-6 months of systemic therapy, I would discuss the case at a multidisciplinary tumor board for consideration of SBRT and other local therapy options. The patient should understand that the purpose of local therapy in this case is to provide a chemotherapy-free interval (not to cure the disease).

I think it depends on the interval of time between end of treatment and recurrence. For most patients, recurrence will occur within the first few years after completing adjuvant therapy, and for those patients, systemic therapy is the most appropriate course. However, occasionally there will be a patient with a prolonged disease-free interval for which local therapy could be indicated. If local therapy is recommended, it must be couched in the understanding that cure with local therapy +/- systemic therapy is unlikely.

Was it Ampullary Ca? Some of these are BRCA enriched and NGS testing can be helpful.