Int J Radiat Oncol Biol Phys 2022 Jul 04
A Critical Review of the Role of Local Therapy for Oligometastatic Gastrointestinal Cancer.
Abstract
Purpose
The purpose of this critical review is to provide an overview of the role and outcomes associated with the use of local therapy for patients with oligometastatic gastrointestinal cancers.
Materials and methods
A review of clinical data was performed to describe outcomes associated with the use of systemic therapy and/or locoregional therapies for patients with oligometastatic gastrointestinal cancers including esophagus, gastric, liver, biliary, pancreas, colorectal, and anal canal.
Results
This review describes outcomes associated with current first line systemic therapy and oligometastasis directed locoregional therapy for patients with gastrointestinal cancers. Available data suggest that for well selected patients amongst each gastrointestinal disease subsite, the use of local therapy is associated with favorable disease control and possible survival benefit.
Conclusions
These data emphasize the importance of multi-disciplinary collaboration and consideration of radiotherapy for patients with oligometastatic gastrointestinal cancers to improve locoregional control and progression-free survival. Multiple trials are ongoing to determine if metastasis-directed radiotherapy improves overall survival.
Related Questions
Would you offer consolidative full dose chemo-RT for local residual pancreatic disease in a patient with stage IV pancreatic adenocarcinoma with excellent response after induction chemotherapy?
I think radiotherapy can selectively be considered in patients like this. The potential roles of radiation therapy could include: Palliation of local symptoms. RT is very effective at palliating symptoms such as pain related to celiac plexus infiltration, etc. Lawrence et al., Journal of Clinical O...
Would you offer local therapy to a patient with GEJ adenocarcinoma with FDG-avid para-aortic node oligometastasis?
I have favored induction systemic therapy and interval re-assessment. If responsive or at least stable disease, I have offered extended field CRT as long as the treatment volume seems reasonable and my perception is that it would be tolerable when assessed in the context of a patient’s performance s...
Would you offer a palliative or more aggressive course of radiation therapy for a symptomatic isolated supraclavicular recurrence of a squamous cell carcinoma of the esophagus?
Such early disease progression suggests there was likely occult involvement of the supraclavicular lymph node at the time of initial diagnosis. My decisions on management would hinge upon the extent of initial CRT field.If the supraclavicular lymph node was in field, I would favor a systemic treatme...