Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe
Tiuri E. Kroese, Hanneke W.M. van Laarhoven, Sebastian F. Schoppman, Pieter Deseyne, Eric Van Cutsem, Karin Haustermans, Philippe Nafteux, Mélissa Thomas, Radka Obermannová, Hanna Rahbek Mortensen, Marianne Nordsmark, Per Pfeiffer, Anneli Elme, Antoine Adenis, Guillaume Piessen, Christiane J. Bruns, Florian Lordick, Ines Gockel, Markus Moehler, Cihan Gani, Theodore Liakakos, John V. Reynolds, A.G. Morganti, Riccardo Rosati, Carlo Castoro, Francesco Cellini, Domenico D’Ugo, Franco Roviello, Maria Bencivenga, Giovanni De Manzoni, Mark I. van Berge Henegouwen, Maarten C.C.M. Hulshof, Jolanda van Dieren, Marieke A. Vollebergh, Johanna W. van Sandick, Paul M. Jeene, C.T. Muijs, Marije Slingerland, Francine E.M. Voncken, Henk H. Hartgrink, Geert-Jan Creemers, Maurice J.C. van der Sangen, Grard A. P. Nieuwenhuijzen, Maaike Berbée, Marcel Verheij, Bas P. L. Wijnhoven, Laurens V. Beerepoot, Nadia Haj Mohammad, Stella Mook, Jelle P. Ruurda, Piotr Kołodziejczyk, Wojciech Polkowski, Lucjan Wyrwicz, María Alsina, Manuel Pera, Tania Fleitas, Andrés Cervantes, Magnus Nilsson, Stefan Mönig, Dorothea Wagner, Matthias Gückenberger, Ewen A. Griffiths, Elizabeth Smyth, George B. Hanna, Sheraz R. Markar, M. Asif Chaudry, M. Hawkins, Edward Cheong, Richard van Hillegersberg, Peter S.N. van Rossum, Tom Rozema, Joos Heisterkamp, Markus Schaefer, E.M. Ozsahin, Jacco J. de Haan, Jan Willem van den Berg, Frédéric Duprez, Eduard Callebout, Elke Van Daele, Ulrich Hacker, Albrecht Hoffmeister, Thomas Kuhnt, Timm Denecke, Regine Kluge, Gerald W. Prager, Aysegül Ilhan‐Mutlu, Dajana Cuicchi, Andrea Ardizzoni, Camiel Rosman, Elske C. Gootjes, Heidi Rütten, Francesco Puccetti, Stefano Cascinu, N. Slim, Maria Eugenia Barrios, Maria Carmen Fernandez, Roberto Martí-Oriol, Marisol Huerta Alvaro, Almudena Vera, E. Jordá
Abstract
BACKGROUND: Local treatment improves the outcomes for oligometastatic disease (OMD, i.e. an intermediate state between locoregional and widespread disseminated disease). However, consensus about the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer is lacking. The aim of this study was to develop a multidisciplinary European consensus statement on the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer. METHODS: In total, 65 specialists in the multidisciplinary treatment for oesophagogastric cancer from 49 expert centres across 16 European countries were requested to participate in this Delphi study. The consensus finding process consisted of a starting meeting, 2 online Delphi questionnaire rounds and an online consensus meeting. Input for Delphi questionnaires consisted of (1) a systematic review on definitions of oligometastatic oesophagogastric cancer and (2) a discussion of real-life clinical cases by multidisciplinary teams. Experts were asked to score each statement on a 5-point Likert scale. The agreement was scored to be either absent/poor (<50%), fair (50%-75%) or consensus (≥75%). RESULTS: A total of 48 experts participated in the starting meeting, both Delphi rounds, and the consensus meeting (overall response rate: 71%). OMD was considered in patients with metastatic oesophagogastric cancer limited to 1 organ with ≤3 metastases or 1 extra-regional lymph node station (consensus). In addition, OMD was considered in patients without progression at restaging after systemic therapy (consensus). For patients with synchronous or metachronous OMD with a disease-free interval ≤2 years, systemic therapy followed by restaging to consider local treatment was considered as treatment (consensus). For metachronous OMD with a disease-free interval >2 years, either upfront local treatment or systemic treatment followed by restaging was considered as treatment (fair agreement). CONCLUSION: The OMEC project has resulted in a multidisciplinary European consensus statement for the definition, diagnosis and treatment of oligometastatic oesophagogastric adenocarcinoma and squamous cell cancer. This can be used to standardise inclusion criteria for future clinical trials.