Definitions and treatment of oligometastatic oesophagogastric cancer according to multidisciplinary tumour boards in Europe
Tiuri E. Kroese, Richard van Hillegersberg, Sebastian F. Schoppmann, Pieter Deseyne, Philippe Nafteux, Radka Obermannová, Marianne Nordsmark, Per Pfeiffer, M. Hawkins, Elizabeth Smyth, Sheraz R. Markar, George B. Hanna, Edward Cheong, Asif Chaudry, Anneli Elme, Antoine Adenis, Guillaume Piessen, Cihan Gani, Christiane J. Bruns, Markus Moehler, Theodore Liakakos, John V. Reynolds, A.G. Morganti, Riccardo Rosati, Carlo Castoro, Domenico D’Ugo, Franco Roviello, Maria Bencivenga, Giovanni De Manzoni, Paul M. Jeene, Johanna W. van Sandick, C.T. Muijs, Marije Slingerland, Grard A. P. Nieuwenhuijzen, Bas P. L. Wijnhoven, Laurens V. Beerepoot, Piotr Kołodziejczyk, Wojciech Polkowski, María Alsina, Manuel Pera, Tania Fleitas, Magnus Nilsson, Matthias Gückenberger, Stefan Mönig, Dorothea Wagner, Lucjan Wyrwicz, Maaike Berbée, Ines Gockel, Florian Lordick, Ewen A. Griffiths, Marcel Verheij, Peter S.N. van Rossum, Hanneke W.M. van Laarhoven, Camiel Rosman, H.J.T. Rutten, Elske C. Gootjes, Francine E.M. Vonken, Jolanda M. van Dieren, Marieke A. Vollebergh, Maurice van der Sangen, Geert‐Jan Creemers, Thomas Zander, Hans Schlößer, Stefano Cascinu, Elena Mazza, Roberto Nicoletti, Anna Damascelli, N. Slim, Paolo Passoni, Andrea Cossu, Francesco Puccetti, Lavinia Barbieri, Lorella Fanti, Francesco Azzolini, Federico Ventoruzzo, Antoni Szczepanik, Laura Visa, A. Reig, Tom Roques, Mark Harrison, Bogumiła Ciseł, Agnieszka Pikuła, Magdalena Skórzewska, Hanne Vanommeslaeghe, Elke Van Daele, Piet Pattyn, Karen Geboes, Eduard Callebout, Suzane Ribeiro, Peter van Duijvendijk, Cathrien Tromp, Meindert N. Sosef, Fabienne Warmerdam, Joos Heisterkamp, Joos Heisterkamp, Almudena Vera, E. Jordá, Fernando López‐Mozos, María‐Carmen Fernández‐Moreno, Maria Eugenia Barrios-Carvajal
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.