AlGhamdi Hamza, Dhont Jennifer, Krayem Mohammad, De Bruyn Pauline, Engels Benedikt, Van Gestel Dirk, Van den Begin Robbe
Radiotherapy Department, Jules Bordet Institute, Université Libre de Bruxelles, 1070 Brussels, Belgium.
Oncology Center, King Faisal Medical City, Abha 62523, Saudi Arabia.
Cancers (Basel). 2022 Apr 18;14(8):2046. doi: 10.3390/cancers14082046.
Over the last years, the oligometastatic disease state has gained more and more interest, and randomized trials are now suggesting an added value of stereotactic radiotherapy on all macroscopic disease in oligometastatic patients; but what barriers could impede widespread disease in some patients? In this review, we first discuss the concept of oligometastatic disease and some examples of clinical evidence. We then explore the route to dissemination: the hurdles a tumoral clone has to overtake before it can produce efficient and widespread dissemination. The spectrum theory argues that the range of metastatic patterns encountered in the clinic is the consequence of gradually obtained metastatic abilities of the tumor cells. Tumor clones can obtain these capabilities by Darwinian evolution, hence early in their genetic progression tumors might produce only a limited number of metastases. We illustrate selective dissemination by discussing organ tropism, the preference of different cancer (sub)types to metastasize to certain organs. Finally we discuss biomarkers that may help to distinguish the oligometastatic state.
在过去几年中，寡转移疾病状态越来越受到关注，随机试验表明立体定向放射治疗对寡转移患者的所有宏观病灶具有附加价值；但哪些障碍可能会阻碍某些患者的广泛疾病发生呢？在这篇综述中，我们首先讨论寡转移疾病的概念以及一些临床证据的例子。然后我们探讨转移途径：肿瘤克隆在产生有效且广泛的转移之前必须克服的障碍。谱理论认为，临床中遇到的转移模式范围是肿瘤细胞逐渐获得转移能力的结果。肿瘤克隆可以通过达尔文进化获得这些能力，因此在其基因进展的早期，肿瘤可能仅产生有限数量的转移灶。我们通过讨论器官嗜性，即不同癌症（亚型）转移至某些器官的偏好，来说明选择性转移。最后，我们讨论可能有助于区分寡转移状态的生物标志物。
