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.
Department of Surgery, Utrecht University Medical Center, Utrecht University, Utrecht, the Netherlands.
Eur J Cancer. 2022 Mar;164:18-29. doi: 10.1016/j.ejca.2021.11.032. Epub 2022 Feb 5.
Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking.
To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe.
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%).
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.
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.
关于寡转移型食管胃交界部癌的定义和治疗尚缺乏共识。
评估欧洲多学科肿瘤委员会（MDT）对寡转移型食管胃交界部癌的定义和治疗。
邀请欧洲专家中心（n=49）在其 MDT 中讨论 15 例真实病例，至少有 1 名内科医生、外科医生和放射肿瘤学家参加。这些病例在转移部位和数量、组织学、检测时间（即同步或异时）、原发肿瘤治疗状况以及对全身治疗的反应方面存在差异。主要结局是在诊断时和全身治疗后对寡转移疾病的定义达成一致。次要结局是治疗策略的一致性。寡转移疾病的治疗策略分为 upfront 局部治疗（即转移灶切除术或立体定向放疗）、全身治疗后再分期以考虑局部治疗或全身治疗。MDT 之间的治疗策略一致性评分分为无/差（<50%）、中等（50%-75%）或一致（≥75%）。
共有来自 16 个国家的 47 个 MDT 对病例进行了充分讨论（96%）。寡转移疾病被认为是在肝脏、肺部、腹膜后淋巴结、肾上腺、软组织或骨骼中存在 1-2 个转移灶的患者（共识）。在随访中，在中位时间为 18 周的全身治疗后，如果没有进展或仅寡转移灶的大小进展，被认为是寡转移疾病（共识）。如果在中位时间为 18 周的全身治疗后再分期时病灶数量进展，则不被认为是寡转移疾病（中等一致性）。对于寡转移疾病的治疗策略没有达成共识。
欧洲食管胃交界部癌 MDT 专家中心对寡转移型食管胃交界部癌的定义达成了广泛共识，但在治疗策略方面存在很大的差异。
