1
|
Banerjee S, Booth CM, Bruera E, Büchler MW, Drilon A, Fry TJ, Ghobrial IM, Gianni L, Jain RK, Kroemer G, Llovet JM, Long GV, Pantel K, Pritchard-Jones K, Scher HI, Tabernero J, Weichselbaum RR, Weller M, Wu YL. Two decades of advances in clinical oncology - lessons learned and future directions. Nat Rev Clin Oncol 2024:10.1038/s41571-024-00945-4. [PMID: 39354161 DOI: 10.1038/s41571-024-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/03/2024]
Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- The Institute of Cancer Research, London, UK.
| | | | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, Houston, TX, USA.
| | - Markus W Büchler
- Botton-Champalimaud Pancreatic Cancer, Champalimaud Foundation, Lisbon, Portugal.
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
| | - Terry J Fry
- Department of Paediatrics and Immunology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Aurora, CO, USA.
| | - Irene M Ghobrial
- Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Medical Oncology, Harvard Medical School, Boston, MA, USA.
| | | | - Rakesh K Jain
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France.
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France.
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
| | - Josep M Llovet
- Mount Sinai Liver Cancer Program, Divisions of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Liver Cancer Translational Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia.
| | - Klaus Pantel
- Institute of Tumour Biology, University Cancer Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital (HUVH), Barcelona, Spain.
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, Ludwig Center for Metastasis Research, The University of Chicago, Chicago, IL, USA.
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Moser R, Pfeiffer S, Cala L, Klein E, Kiechle M, Behzadi ST, Fallenberg E, Combs SE, Weber W, Borm KJ. Detecting Metastatic Patterns of Oligometastatic Breast Cancer: A Comparative Analysis of 18F-FDG PET/CT and Conventional CT Imaging. J Nucl Med 2024; 65:845-850. [PMID: 38637138 DOI: 10.2967/jnumed.123.266925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
Metastasis-directed therapy has the potential to improve progression-free and overall survival in oligometastatic disease (OMD). For breast cancer, however, randomized trials have failed so far to confirm this finding. Because the concept of metastasis-directed therapy in OMD is highly dependent on the accuracy of the imaging modality, we aimed to assess the impact of 18F-FDG PET/CT on the definition of OMD in breast cancer patients. Methods: Eighty patients with a total of 150 18F-FDG PET/CT images (between October 2006 and January 2022) were enrolled in this retrospective study at the Technical University of Munich. The inclusion criteria were OMD, defined as 1-5 distant metastases, at the time of 18F-FDG PET/CT. For the current study, we systemically compared the metastatic pattern on 18F-FDG PET/CT with conventional CT. Results: At the time of 18F-FDG PET/CT, 21.3% of patients (n = 32) had a first-time diagnosis of metastatic disease, 40.7% (n = 61) had a previous history of OMD, and 38% (n = 57) had a previous history of polymetastatic disease. In 45.3% of cases, the imaging modality (18F-FDG PET/CT vs. conventional CT) had an impact on the assessment of whether OMD was present. An identical metastatic pattern was observed in only 32% of cases.18F-FDG PET/CT detected additional metastases in 33.3% of cases, mostly in the nonregional lymph node system. Conclusion: The use of 18F-FDG PET/CT had a substantial impact on the definition of OMD and detection of metastatic pattern in breast cancer. Our results emphasize the importance of establishing a standardized definition for imaging modalities in future trials and clinical practices related to metastasis-directed therapy in breast cancer patients.
Collapse
Affiliation(s)
- Rebecca Moser
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Sophie Pfeiffer
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Lisena Cala
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Sophie T Behzadi
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Eva Fallenberg
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
- Department of Radiation Sciences, Germany Institute of Innovative Radiotherapy, Helmholtz Zentrum München, Oberschleißheim, Germany; and
- German Consortium for Translational Cancer Research, Munich, Germany
| | - Wolfgang Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany
| | - Kai J Borm
- Department of Radiation Oncology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University Munich, Munich, Germany;
| |
Collapse
|
3
|
Widder J, Simek IM, Goldner GM, Heilemann G, Ubbels JF. Metastases-directed local therapies (MDT) beyond genuine oligometastatic disease (OMD): Indications, endpoints and the role of imaging. Clin Transl Radiat Oncol 2024; 45:100729. [PMID: 38298549 PMCID: PMC10827679 DOI: 10.1016/j.ctro.2024.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
To further personalise treatment in metastatic cancer, the indications for metastases-directed local therapy (MDT) and the biology of oligometastatic disease (OMD) should be kept conceptually apart. Both need to be vigorously investigated. Tumour growth dynamics - growth rate combined with metastatic seeding efficiency - is the single most important biological feature determining the likelihood of success of MDT in an individual patient, which might even be beneficial in slowly developing polymetastatic disease. This can be reasonably well assessed using appropriate clinical imaging. In the context of considering appropriate indications for MDT, detecting metastases at the edge of image resolution should therefore suggest postponing MDT. While three to five lesions are typically used to define OMD, it could be argued that countability throughout the course of metastatic disease, rather than a specific maximum number of lesions, could serve as a better parameter for guiding MDT. Here we argue that the unit of MDT as a treatment option in metastatic cancer might best be defined not as a single procedure at a single point in time, but as a series of treatments that can be delivered in a single or multiple sessions to different lesions over time. Newly emerging lesions that remain amenable to MDT without triggering the start of a new systemic treatment, a change in systemic therapy, or initiation of best supportive care, would thus not constitute a failure of MDT. This would have implications for defining endpoints in clinical trials and registries: Rather than with any disease progression, failure of MDT would only be declared when there is progression to polymetastatic disease, which then precludes further options for MDT.
Collapse
Affiliation(s)
- Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Inga-Malin Simek
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Gregor M. Goldner
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Gerd Heilemann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Jan F. Ubbels
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
de Ortiz de Choudens S, Visotcky A, Banerjee A, Aldakkak M, Tsai S, Evans DB, Christians KK, Clarke CN, George B, Shreenivas A, Kamgar M, Chakrabarti S, Dua KS, Khan AH, Madhavan S, Erickson BA, Hall WA. Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy. Cancer Med 2024; 13:e6582. [PMID: 38140796 PMCID: PMC10807686 DOI: 10.1002/cam4.6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/28/2023] [Accepted: 09/13/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE/OBJECTIVES Most patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC. MATERIALS/METHODS Patients presenting with metastatic PDAC that received treatment at our institution with FOLFIRINOX or gemcitabine-based chemotherapies between August 1, 2011 and September 1, 2017 were included in the study. Metastatic disease burden was comprehensively characterized radiologically via individual diagnostic imaging segmentation. Landmark analysis was performed at 18 months, and survival curves were estimated using the Kaplan-Meier method and compared between groups via the log-rank test. ECOG and Charlson Comorbidity Index (CCI) were calculated for all patients. RESULTS 121 patients were included with a median age of 62 years (37-86), 40% were female, 25% had ECOG 0 at presentation. Of the 121 patients included, 33% (n = 41) were alive at 12 months and 25% (n = 31) were alive at 18 months. Landmark analysis demonstrated a significant difference between patients surviving <18 months and ≥18 months regarding the presence of lung only metastases (36% vs. 16%, p = 0.04), number of organs with metastases (≥2 vs. 1, p = 0.04), and disease volume (mean of 19.1 cc vs. 1.4 cc, p = 0.04). At Year 1, predictors for improved OS included ECOG status at diagnosis (ECOG 0 vs. ECOG 1, p = 0.04), metastatic disease volume at diagnosis (≤0.1 cc vs. >60 cc, p = 0.004), metastasis only in the liver (p = 0.04), and normalization of CA 19-9 (p < 0.001). At Year 2, the only predictor of improved OS was normalization of the CA 19-9 (p = 0.03). In those patients that normalized their CA 19-9, median overall survival was 16 months. CONCLUSIONS In this exploratory analysis normalization of CA-19-9 or volumetric metastatic disease burden less than 0.2 cc demonstrated a remarkable OS, similar to that of patients with non-metastatic disease. These metrics are useful for counseling patients and identifying cohorts that may be optimal for trials exploring metastatic and/or local tumor-directed interventions.
Collapse
Affiliation(s)
| | - Alexis Visotcky
- Division of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Anjishnu Banerjee
- Division of BiostatisticsMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Mohammed Aldakkak
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Susan Tsai
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Douglas B. Evans
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Kathleen K. Christians
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Callisia N. Clarke
- Department of SurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - Ben George
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Aditya Shreenivas
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Mandana Kamgar
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Sakti Chakrabarti
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Kulwinder S. Dua
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Abdul Haq Khan
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Srivats Madhavan
- Division of Medical OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- Division of GastroenterologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Beth A. Erickson
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| | - William A. Hall
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWisconsinUSA
- LaBahn Pancreatic Cancer ProgramMilwaukeeWisconsinUSA
| |
Collapse
|
5
|
Izmailov T, Ryzhkin S, Borshchev G, Boichuk S. Oligometastatic Disease (OMD): The Classification and Practical Review of Prospective Trials. Cancers (Basel) 2023; 15:5234. [PMID: 37958408 PMCID: PMC10648904 DOI: 10.3390/cancers15215234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/15/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Oligometastatic disease (OMD) is currently known as an intermediate state of cancer, characterized by a limited number of systemic metastatic lesions for which local ablative therapy could be curative. Indeed, data from multiple clinical trials have illustrated an increase in overall survival (OS) for cancer patients when local ablative therapy was included in the systemic adjuvant therapy. Given that no driver and somatic mutations specific to OMD are currently established, the diagnosis of OMD is mainly based on the results of X-ray studies. In 2020, 20 international experts from the European Society for Radiotherapy and Oncology (ESTRO) and the European Organization for Research and Treatment of Cancer (EORTC) developed a comprehensive system for the characterization and classification of OMD. They identified 17 OMD characteristics that needed to be assessed in all patients who underwent radical local treatment. These characteristics reflect the tumor biology and clinical features of the disease underlying the development of OMD independently of the primary tumor type and the number of metastatic lesions. In particular, the system involves the characteristics of the primary tumor (e.g., localization, histology, TNM stage, mutational status, specific tumor markers), clinical parameters (e.g., disease-free interval, treatment-free interval), therapies (e.g., local, radical or palliative treatment, the numbers of the therapeutic regimens), and type of OMD (e.g., invasive). Based on the aforementioned criteria, an algorithm was introduced into the clinic to classify OMDs collectively according to their nomenclature. A history of polymetastatic disease (PMD) prior to OMD is used as a criterion to delineate between induced OMD (previous history of PMD after successful therapy) and genuine OMD (no history of PMD). Genuine OMD is divided into two states: recurrent OMD (i.e., after a previous history of OMD) and de novo OMD (i.e., a first newly diagnosed oligometastatic disease). de novo OMD is differentiated into synchronous and metachronous forms depending on the length of time from the primary diagnosis to the first evidence of OMD. In the case of synchronous OMD, this period is less than 6 months. Lastly, metachronous and induced OMD are divided into oligorecurrence, oligoprogression, and oligopersistence, depending on whether OMD is firstly diagnosed during an absence (oligo recurrence) or presence (oligoprogression or oligopersistence) of active systemic therapy. This classification and nomenclature of OMD are evaluated prospectively in the OligoCare study. In this article, we present a practical review of the current concept of OMD and discuss the available prospective clinical trials and potential future directions.
Collapse
Affiliation(s)
- Timur Izmailov
- Pirogov National Medical and Surgical Center, Ministry of Health of Russia, Moscow 127994, Russia; (T.I.); (G.B.)
- Department of Radiotherapy and Radiology, Russian Medical Academy of Continuous Professional Education, Moscow 127051, Russia;
| | - Sergey Ryzhkin
- Department of Radiotherapy and Radiology, Russian Medical Academy of Continuous Professional Education, Moscow 127051, Russia;
- Department of Hygiene, Kazan State Medical University, Kazan 420012, Russia
| | - Gleb Borshchev
- Pirogov National Medical and Surgical Center, Ministry of Health of Russia, Moscow 127994, Russia; (T.I.); (G.B.)
| | - Sergei Boichuk
- Department of Radiotherapy and Radiology, Russian Medical Academy of Continuous Professional Education, Moscow 127051, Russia;
- Department of Pathology, Kazan State Medical University, Kazan 420012, Russia
- “Biomarker” Research Laboratory, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan 420008, Russia
| |
Collapse
|
6
|
Chen YN, Shih CY, Guo SL, Liu CY, Shen MH, Chang SC, Ku WC, Huang CC, Huang CJ. Potential prognostic and predictive value of UBE2N, IMPDH1, DYNC1LI1 and HRASLS2 in colorectal cancer stool specimens. Biomed Rep 2023; 18:22. [PMID: 36846616 PMCID: PMC9945078 DOI: 10.3892/br.2023.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
Colorectal cancer (CRC) is the most common gastrointestinal malignancy worldwide. The poor specificity and sensitivity of the fecal occult blood test has prompted the development of CRC-related genetic markers for CRC screening and treatment. Gene expression profiles in stool specimens are effective, sensitive and clinically applicable. Herein, a novel advantage of using cells shed from the colon is presented for cost-effective CRC screening. Molecular panels were generated through a series of leave-one-out cross-validation and discriminant analyses. A logistic regression model following reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry was used to validate a specific panel for CRC prediction. The panel, consisting of ubiquitin-conjugating enzyme E2 N (UBE2N), inosine monophosphate dehydrogenase 1 (IMPDH1), dynein cytoplasmic 1 light intermediate chain 1 (DYNC1LI1) and phospholipase A and acyltransferase 2 (HRASLS2), accurately recognized patients with CRC and could thus be further investigated as a potential prognostic and predictive biomarker for CRC. UBE2N, IMPDH1 and DYNC1LI1 expression levels were upregulated and HRASLS2 expression was downregulated in CRC tissues. The predictive power of the panel was 96.6% [95% confidence interval (CI), 88.1-99.6%] sensitivity and 89.7% (95% CI, 72.6-97.8%) specificity at a predicted cut-off value at 0.540, suggesting that this four-gene panel testing of stool specimens can faithfully mirror the state of the colon. On the whole, the present study demonstrates that screening for CRC or cancer detection in stool specimens collected non-invasively does not require the inclusion of an excessive number of genes, and colonic defects can be identified via the detection of an aberrant protein in the mucosa or submucosa.
Collapse
Affiliation(s)
- Yu-Nung Chen
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C
| | - Cheng-Yen Shih
- Division of Gastroenterology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei 22174, Taiwan, R.O.C
| | - Shu-Lin Guo
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Department of Anesthesiology, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C,Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan, R.O.C
| | - Chih-Yi Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Division of Pathology, Sijhih Cathay General Hospital, New Taipei City 22174, Taiwan, R.O.C
| | - Ming-Hung Shen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Department of Surgery, Fu Jen Catholic University Hospital, New Taipei 24352, Taiwan, R.O.C.,PhD Program in Nutrition and Food Science, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Shih-Chang Chang
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C
| | - Wei-Chi Ku
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10090, Taiwan, R.O.C.,Correspondence to: Dr Chi-Cheng Huang, Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217, Taiwan, R.O.C.
| | - Chi-Jung Huang
- Department of Medical Research, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C.,Department of Biochemistry, National Defense Medical Center, Taipei 11490, Taiwan, R.O.C.,Correspondence to: Dr Chi-Cheng Huang, Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217, Taiwan, R.O.C.
| |
Collapse
|
7
|
Ratnakumaran R, McDonald F. The Management of Oligometastases in Non-small Cell Lung Cancer - is Stereotactic Ablative Radiotherapy now Standard of Care? Clin Oncol (R Coll Radiol) 2022; 34:753-760. [PMID: 36117126 DOI: 10.1016/j.clon.2022.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
Oligometastatic non-small cell lung cancer encompasses a number of distinct clinical scenarios with a pattern of limited tumour burden on imaging. Delivering local ablative therapy to individual metastatic lesions may assist in disease modification and contribute to improved outcomes. We review the published randomised clinical trials that support the implementation of stereotactic ablative radiotherapy as a standard of care in certain oligometastatic non-small cell lung cancer clinical scenarios, and highlight the current knowledge gaps and areas of ongoing research.
Collapse
Affiliation(s)
- R Ratnakumaran
- The Lung Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK.
| | - F McDonald
- The Lung Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| |
Collapse
|
8
|
Liu CS, Song YQ, Wang RZ, Wang Z, He R, Xu K, Wang CY, Wu Y, Wang Y, Zhang XF, Li G, Wang TL. Thorax radiotherapy using 18F-positron emission tomography/computed tomography-guided precision radiotherapy is a prognostic factor for survival in patients with extracranial oligometastatic non-small cell lung cancer:A two-center propensity score-matched analysis. Front Oncol 2022; 12:991378. [PMID: 36353556 PMCID: PMC9639371 DOI: 10.3389/fonc.2022.991378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background This retrospective study compared positron emission tomography (PET)/computed tomography (CT) and CT in the treatment of extracranial oligometastatic non-small-cell lung cancer (NSCLC) and explored the impact of thorax radiotherapy (TRT) on patient survival. Methods We reviewed the medical records of Chinese patients with stage IV extracranial oligometastatic NSCLC who underwent PET/CT or CT at two centers. Propensity score matching (PSM) was used to control differences in patient characteristics between the maintenance chemotherapy alone and TRT plus maintenance chemotherapy groups. Results We analyzed 192 eligible patients. The median survival time was better in patients who received PET/CT than in those who only received CT (n = 192, 16 months vs. 6 months, p<0.001). Subgroup analysis showed the median survival time was significantly longer in the TRT plus maintenance group than in the chemotherapy alone group in patients who underwent PET/CT examinations (n = 94, 25 months vs. 11 months, p<0.001). However, there was no statistical difference in survival between both groups in patients who underwent CT examinations (n = 98, 8 months vs. 5 months, p = 0.180). A multifactorial analysis revealed a more favorable prognosis in patients who underwent PET/CT evaluation (HR: 0.343, 95% CI: 0.250-0.471, p <0.001) and TRT (HR: 0.624, 95% CI: 0.464-0.840, p = 0.002), than in those who did not. PSM was consistent with these results. Conclusions PET/CT-guided TRT is associated with improved clinical outcomes in patients with stage IV extracranial oligometastatic NSCLC.
Collapse
Affiliation(s)
- Cheng-Sen Liu
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Ying-Qiu Song
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Run-Ze Wang
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Zheng Wang
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Rong He
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Ke Xu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Chen-Yu Wang
- Department of Information Management, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Yu Wu
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Ye Wang
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Xiao-fang Zhang
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Guang Li
- Department of Radiotherapy, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tian-Lu Wang
- Department of Radiotherapy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
- *Correspondence: Tian-Lu Wang,
| |
Collapse
|
9
|
Deek MP, Van der Eecken K, Sutera P, Deek RA, Fonteyne V, Mendes AA, Decaestecker K, Kiess AP, Lumen N, Phillips R, De Bruycker A, Mishra M, Rana Z, Molitoris J, Lambert B, Delrue L, Wang H, Lowe K, Verbeke S, Van Dorpe J, Bultijnck R, Villeirs G, De Man K, Ameye F, Song DY, DeWeese T, Paller CJ, Feng FY, Wyatt A, Pienta KJ, Diehn M, Bentzen SM, Joniau S, Vanhaverbeke F, De Meerleer G, Antonarakis ES, Lotan TL, Berlin A, Siva S, Ost P, Tran PT. Long-Term Outcomes and Genetic Predictors of Response to Metastasis-Directed Therapy Versus Observation in Oligometastatic Prostate Cancer: Analysis of STOMP and ORIOLE Trials. J Clin Oncol 2022; 40:3377-3382. [PMID: 36001857 PMCID: PMC10166371 DOI: 10.1200/jco.22.00644] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/02/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The initial STOMP and ORIOLE trial reports suggested that metastasis-directed therapy (MDT) in oligometastatic castration-sensitive prostate cancer (omCSPC) was associated with improved treatment outcomes. Here, we present long-term outcomes of MDT in omCSPC by pooling STOMP and ORIOLE and assess the ability of a high-risk mutational signature to risk stratify outcomes after MDT. The primary end point was progression-free survival (PFS) calculated using the Kaplan-Meier method. High-risk mutations were defined as pathogenic somatic mutations within ATM, BRCA1/2, Rb1, or TP53. The median follow-up for the whole group was 52.5 months. Median PFS was prolonged with MDT compared with observation (pooled hazard ratio [HR], 0.44; 95% CI, 0.29 to 0.66; P value < .001), with the largest benefit of MDT in patients with a high-risk mutation (HR high-risk, 0.05; HR no high-risk, 0.42; P value for interaction: .12). Within the MDT cohort, the PFS was 13.4 months in those without a high-risk mutation, compared with 7.5 months in those with a high-risk mutation (HR, 0.53; 95% CI, 0.25 to 1.11; P = .09). Long-term outcomes from the only two randomized trials in omCSPC suggest a sustained clinical benefit to MDT over observation. A high-risk mutational signature may help risk stratify treatment outcomes after MDT.
Collapse
Affiliation(s)
- Matthew P. Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kim Van der Eecken
- Department of Pathology and Human Structure and Repair, University of Ghent, Ghent, Belgium
| | - Philip Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca A. Deek
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Adrianna A. Mendes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ana Ponce Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolaas Lumen
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Ryan Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Zaker Rana
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Bieke Lambert
- Department of Radiology and Nuclear Medicine, Ghent University, and Department of Nuclear Medicine, AZ Maria-Middelares Ghent, Belgium
| | - Louke Delrue
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Hailun Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn Lowe
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Renée Bultijnck
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University, and Department of Nuclear Medicine, AZ Maria-Middelares Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria-Middelares Ghent, Ghent, Belgium
| | - Daniel Y. Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Theodore DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Channing J. Paller
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Felix Y. Feng
- Departments of Medicine, Urology and Radiation Oncology, UCSF, San Francisco, CA
| | - Alexander Wyatt
- Department of Urologic Sciences, University of British Columbia, and Vancouver Prostate Centre, Vancouver, Canada
| | - Kenneth J. Pienta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Maximillian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Soren M. Bentzen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Steven Joniau
- Department of Urology, Catholic University Leuven, Leuven, Belgium
| | | | - Gert De Meerleer
- Department of Radiation Oncology, Catholic University Leuven, Leuven, Belgium
| | | | - Tamara L. Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Melbourne Australia
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Phuoc T. Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
10
|
Santos PMG, Li X, Gomez DR. Local Consolidative Therapy for Oligometastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:3977. [PMID: 36010969 PMCID: PMC9406686 DOI: 10.3390/cancers14163977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
In the last 20 years, significant strides have been made in our understanding of the biological mechanisms driving disease pathogenesis in metastatic non-small cell lung cancer (NSCLC). Notably, the development and application of predictive biomarkers as well as refined treatment regimens in the form of chemoimmunotherapy and novel targeted agents have led to substantial improvements in survival. Parallel to these remarkable advancements in modern systemic therapy has been a growing recognition of "oligometastatic disease" as a distinct clinical entity-defined by the presence of a controlled primary tumor and ≤5 sites of metastatic disease amenable to local consolidative therapy (LAT), with surgery or stereotactic ablative body radiotherapy (SABR). To date, three randomized studies have provided clinical evidence supporting the use of LAT/SABR in the treatment of oligometastatic NSCLC. In this review, we summarize clinical evidence from these landmark studies and highlight ongoing trials evaluating the use of LAT/SABR in a variety of clinical contexts along the oligometastatic disease spectrum. We discuss important implications and caveats of the available data, including considerations surrounding patient selection and application in routine clinical practice. We conclude by offering potential avenues for further investigation in the oligometastatic disease space.
Collapse
Affiliation(s)
| | | | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| |
Collapse
|
11
|
Integrated 18F-FDG PET/CT parameter defines metabolic oligometastatic non-small cell lung cancer. Nucl Med Commun 2022; 43:1026-1033. [DOI: 10.1097/mnm.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Stratification of Oligometastatic Prostate Cancer Patients by Liquid Biopsy: Clinical Insights from a Pilot Study. Biomedicines 2022; 10:biomedicines10061321. [PMID: 35740343 PMCID: PMC9219949 DOI: 10.3390/biomedicines10061321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
We propose a pilot, prospective, translational study with the aim of identifying possible molecular markers underlying metastatic prostate cancer (PC) evolution with the use of liquid biopsy. Twenty-eight castrate sensitive, oligometastatic PC patients undergoing bone and/or nodal stereotactic body radiotherapy (SBRT) were recruited. Peripheral blood samples were collected before the commencement of SBRT, then they were processed for circulating cell free DNA (cfDNA) extraction. Deep targeted sequencing was performed using a custom gene panel. The primary endpoint was to identify differences in the molecular contribution between the oligometastatic and polymetastatic evolution of PC to same-first oligo-recurrent disease presentation. Seventy-seven mutations were detected in 25/28 cfDNA samples: ATM in 14 (50%) cases, BRCA2 11 (39%), BRCA1 6 (21%), AR 13 (46%), ETV4, and ETV6 2 (7%). SBRT failure was associated with an increased risk of harboring the BRCA1 mutation (OR 10.5) (p = 0.043). The median cfDNA concentration was 24.02 ng/mL for ATM mutation carriers vs. 40.04 ng/mL for non-carriers (p = 0.039). Real-time molecular characterization of oligometastatic PC may allow for the identification of a true oligometastatic phenotype, with a stable disease over a long time being more likely to benefit from local, curative treatments or the achievement of long-term disease control. A prospective validation of our promising findings is desirable for a better understanding of the real impact of liquid biopsy in detecting tumor aggressiveness and clonal evolution.
Collapse
|
13
|
Oligometastasis in breast cancer—current status and treatment options from a radiation oncology perspective. Strahlenther Onkol 2022; 198:601-611. [PMID: 35527272 PMCID: PMC9217902 DOI: 10.1007/s00066-022-01938-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/24/2022] [Indexed: 12/16/2022]
Abstract
AbstractEvidence from a few small randomized trials and retrospective cohorts mostly including various tumor entities indicates a prolongation of disease free survival (DFS) and overall survival (OS) from local ablative therapies in oligometastatic disease (OMD). However, it is still unclear which patients benefit most from this approach. We give an overview of the several aspects of stereotactic body radiotherapy (SBRT) in extracranial OMD in breast cancer from a radiation oncology perspective. A PubMed search referring to this was conducted. An attempt was made to relate the therapeutic efficacy of SBRT to various prognostic factors. Data from approximately 500 breast cancer patients treated with SBRT for OMD in mostly in small cohort studies have been published, consistently indicating high local tumor control rates and favorable progression-free (PFS) and overall survival (OS). Predictors for a good prognosis after SBRT are favorable biological subtype (hormone receptor positive, HER2 negative), solitary metastasis, bone-only metastasis, and long metastasis-free interval. However, definitive proof that SBRT in OMD breast cancer prolongs DFS or OS is lacking, since, with the exception of one small randomized trial (n = 22 in the SBRT arm), none of the cohort studies had an adequate control group. Further studies are needed to prove the benefit of SBRT in OMD breast cancer and to define adequate selection criteria. Currently, the use of local ablative SBRT should always be discussed in a multidisciplinary tumor board.
Collapse
|
14
|
Filippini Velázquez G, Schiele S, Gerken M, Neumaier S, Hackl C, Mayr P, Klinkhammer-Schalke M, Illerhaus G, Schlitt HJ, Anthuber M, Kröncke T, Messmann H, Märkl B, Schmid C, Trepel M, Müller G, Claus R, Hackanson B. Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer. ESMO Open 2022; 7:100470. [PMID: 35461024 PMCID: PMC9271475 DOI: 10.1016/j.esmoop.2022.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential. Patients and methods In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC). Results Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC. Conclusions Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice. We identified four variables of adverse outcome for patients treated with surgical resection of liver metastases from CRC. Adverse variables were inflammatory response to the tumor, multiple metastases, right-sided primary tumor, node-positive primary tumor. We developed a preoperative clinical score according to the number of risk factors present. Using easily obtainable variables, this score identified patients with oligometastatic CRC with good prognosis. Patients without risk factors should strongly be considered for surgical resection of their metastases.
Collapse
Affiliation(s)
- G Filippini Velázquez
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - S Schiele
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - M Gerken
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - S Neumaier
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - C Hackl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - P Mayr
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Klinkhammer-Schalke
- Tumor Center Regensburg, Institute for Quality Assurance and Health Service Research, University of Regensburg, Regensburg, Germany
| | - G Illerhaus
- Department of Haematology and Oncology, Katharinen Hospital Stuttgart, Stuttgart, Germany
| | - H J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - M Anthuber
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - T Kröncke
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - H Messmann
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - B Märkl
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - C Schmid
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - M Trepel
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany
| | - G Müller
- Faculty of Applied Mathematics and Statistics, University of Augsburg, Augsburg, Germany
| | - R Claus
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; General Pathology and Molecular Diagnostics, Faculty of Medicine, University of Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Hackanson
- Comprehensive Cancer Center Augsburg (CCCA), University Medical Center Augsburg, Augsburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
15
|
Greco C, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Antunes I, Vasconcelos AL, Kociolek J, Castanheira J, Oliveira C, Silva A, Vaz S, Oliveira F, Carrasquinha E, Costa D, Fuks Z. Positron Emission Tomography-Derived Metrics Predict the Probability of Local Relapse After Oligometastasis-Directed Ablative Radiation Therapy. Adv Radiat Oncol 2022; 7:100864. [PMID: 35036636 PMCID: PMC8752878 DOI: 10.1016/j.adro.2021.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Early positron emission tomography-derived metrics post-oligometastasis radioablation may predict impending local relapses (LRs), providing a basis for a timely ablation. METHODS AND MATERIALS Positron emission tomography data of 623 lesions treated with either 24 Gy single-dose radiation therapy (SDRT) (n = 475) or 3 × 9 Gy stereotactic body radiation therapy (SBRT) (n = 148) were analyzed in a training data set (n = 246) to obtain optimal cutoffs for pretreatment maximum standardized uptake value (SUVmax) and its 3-month posttreatment decline (ΔSUVmax) in predicting LR risk, validated in a data set unseen to testing (n = 377). RESULTS At a median of 21.7 months, 91 lesions developed LRs: 39 of 475 (8.2%) after SDRT and 52 of 148 (35.1%) after SBRT. The optimal cutoff values were 12 for SUVmax and -75% for ΔSUVmax. Bivariate SUVmax/ΔSUVmax permutations rendered a 3-tiered LR risk stratification of dual-favorable (low risk), 1 adverse (intermediate risk) and dual-adverse (high risk). Actuarial 5-year local relapse-free survival rates were 93.9% versus 89.6% versus 57.1% (P < .0001) and 76.1% versus 48.3% versus 8.2% (P < .0001) for SDRT and SBRT, respectively. The SBRT area under the ROC curve was 0.71 (95% CI, 0.61-0.79) and the high-risk subgroup yielded a 76.5% true positive LR prediction rate. CONCLUSIONS The SBRT dual-adverse SUVmax/ΔSUVmax category LR prediction power provides a basis for prospective studies testing whether a timely ablation of impending LRs affects oligometastasis outcomes.
Collapse
Affiliation(s)
- Carlo Greco
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Javier Morales
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Antunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Luisa Vasconcelos
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Justyna Kociolek
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joana Castanheira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carla Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Angelo Silva
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sofia Vaz
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Francisco Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Eunice Carrasquinha
- Computational Clinical Imaging Group, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Durval Costa
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
16
|
Dhiman A, Vining CC, Witmer HDD, Sood D, Shergill A, Kindler H, Roggin KK, Posner MC, Ahmed OS, Liauw S, Pitroda S, Liao CY, Karrison T, Weichselbaum R, Polite B, Eng OS, Catenacci DVT, Turaga KK. Phase II Prospective, Open-Label Randomized Controlled Trial Comparing Standard of Care Chemotherapy With and Without Sequential Cytoreductive Interventions for Patients with Oligometastatic Foregut Adenocarcinoma and Undetectable Circulating Tumor Deoxyribose Nucleic Acid (ctDNA) Levels. Ann Surg Oncol 2022; 29:10.1245/s10434-021-11249-7. [PMID: 34988836 PMCID: PMC8730296 DOI: 10.1245/s10434-021-11249-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metastatic adenocarcinomas of foregut origin are aggressive and have limited treatment options, poor quality of life, and a dismal prognosis. A subset of such patients with limited metastatic disease might have favorable outcomes with locoregional metastasis-directed therapies. This study investigates the role of sequential cytoreductive interventions in addition to the standard of care chemotherapy in patients with oligometastatic foregut adenocarcinoma. METHODS This is a single-center, phase II, open-label randomized clinical trial. Eligible patients include adults with synchronous or metachronous oligometastatic (metastasis limited to two sites and amenable for curative/ablative treatment) adenocarcinoma of the foregut without progression after induction chemotherapy and having undetectable ctDNA. These patients will undergo induction chemotherapy and will then be randomized (1:1) to either sequential curative intervention followed by maintenance chemotherapy versus routine continued chemotherapy. The primary endpoint is progression-free survival (PFS), and a total of 48 patients will be enrolled to detect an improvement in the median PFS in the intervention arm with a hazard ratio (HR) of 0.5 with 80% power and a one-sided alpha of 0.1. Secondary endpoints include disease-free survival (DFS) in the intervention arm, overall survival (OS), ctDNA conversion rate pre/post-induction chemotherapy, ctDNA PFS, PFS2, adverse events, quality of life, and financial toxicity. DISCUSSION This is the first randomized study that aims to prospectively evaluate the efficacy and safety of surgical/ablative interventions in patients with ctDNA-negative oligometastatic adenocarcinoma of foregut origin post-induction chemotherapy. The results from this study will likely develop pertinent, timely, and relevant knowledge in oncology.
Collapse
Affiliation(s)
- Ankit Dhiman
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Charles C Vining
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hunter D D Witmer
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Divya Sood
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Ardaman Shergill
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Hedy Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kevin K Roggin
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Mitchell C Posner
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | | | - Stanley Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Sean Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Chih-Yi Liao
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Theodore Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
- The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - Blase Polite
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel V T Catenacci
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| |
Collapse
|
17
|
Non-coding RNA-mediated autophagy in cancer: A protumor or antitumor factor? Biochim Biophys Acta Rev Cancer 2021; 1876:188642. [PMID: 34715268 DOI: 10.1016/j.bbcan.2021.188642] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022]
Abstract
Autophagy, usually referred to as macroautophagy, is a cytoprotective behavior that helps cells, especially cancer cells, escape crises. However, the role of autophagy in cancer remains controversial. The induction of autophagy is favorable for tumor growth, as it can degrade damaged cell components accumulated during nutrient deficiency, chemotherapy, or other stresses in a timely manner. Whereas the antitumor effect of autophagy might be closely related to its crosstalk with metabolism, immunomodulation, and other pathways. Recent studies have verified that lncRNAs and circRNAs modulate autophagy in carcinogenesis, cancer cells proliferation, apoptosis, metastasis, and chemoresistance via multiple mechanisms. A comprehensive understanding of the regulatory relationships between ncRNAs and autophagy in cancer might resolve chemoresistance and also offer intervention strategies for cancer therapy. This review systematically displays the regulatory effects of lncRNAs and circRNAs on autophagy in the contexts of cancer initiation, progression, and resistance to chemo- or radiotherapy and provides a novel insight into cancer therapy.
Collapse
|
18
|
Maddipati R, Norgard RJ, Baslan T, Rathi KS, Zhang A, Saeid A, Higashihara T, Wu F, Kumar A, Annamalai V, Bhattacharya S, Raman P, Adkisson CA, Pitarresi JR, Wengyn MD, Yamazoe T, Li J, Balli D, LaRiviere MJ, Ngo TVC, Folkert IW, Millstein ID, Bermeo J, Carpenter EL, McAuliffe JC, Oktay MH, Brekken RA, Lowe SW, Iacobuzio-Donahue CA, Notta F, Stanger BZ. MYC levels regulate metastatic heterogeneity in pancreatic adenocarcinoma. Cancer Discov 2021; 12:542-561. [PMID: 34551968 PMCID: PMC8831468 DOI: 10.1158/2159-8290.cd-20-1826] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 07/26/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Abstract
The degree of metastatic disease varies widely amongst cancer patients and impacts clinical outcomes. However, the biological and functional differences that drive the extent of metastasis are poorly understood. We analyzed primary tumors and paired metastases using a multi-fluorescent lineage-labeled mouse model of pancreatic ductal adenocarcinoma (PDAC) - a tumor type where most patients present with metastases. Genomic and transcriptomic analysis revealed an association between metastatic burden and gene amplification or transcriptional upregulation of MYC and its downstream targets. Functional experiments showed that MYC promotes metastasis by recruiting tumor associated macrophages (TAMs), leading to greater bloodstream intravasation. Consistent with these findings, metastatic progression in human PDAC was associated with activation of MYC signaling pathways and enrichment for MYC amplifications specifically in metastatic patients. Collectively, these results implicate MYC activity as a major determinant of metastatic burden in advanced PDAC.
Collapse
Affiliation(s)
| | - Robert J Norgard
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Timour Baslan
- Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center
| | - Komal S Rathi
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia
| | - Amy Zhang
- PanCuRx Translational Research Initiative, Ontario Institute for Cancer Research
| | - Asal Saeid
- The University of Texas Southwestern Medical Center
| | | | - Feng Wu
- The University of Texas Southwestern Medical Center
| | - Angad Kumar
- Internal Medicine, The University of Texas Southwestern Medical Center
| | - Valli Annamalai
- Department of Internal Medicine, The University of Texas Southwestern Medical Center
| | | | | | | | | | | | - Taiji Yamazoe
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jinyang Li
- School of Medicine, University of Pennsylvania
| | - David Balli
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | | | - Tuong-Vi C Ngo
- Division of Surgical Oncology, Department of Surgery, and Hamon Center for Therapeutic Oncology Research, The University of Texas Southwestern Medical Center
| | | | - Ian D Millstein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jonathan Bermeo
- David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center
| | | | - John C McAuliffe
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center
| | | | - Rolf A Brekken
- Hamon Center for Therapeutic Oncology Research, Departments of Surgery and Pharmacology, UT Southwestern Medical Center at Dallas
| | - Scott W Lowe
- Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center
| | | | | | - Ben Z Stanger
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
19
|
An T, Deng L, Wang Y, Yang Z, Chai C, Ouyang J, Lu X, Zhang C. The prognostic impacts of PABPC1 expression on gastric cancer patients. Future Oncol 2021; 17:4471-4479. [PMID: 34420428 DOI: 10.2217/fon-2021-0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the prognostic impacts of PABPC1 on gastric cancer (GC) patients. Methods: The expression levels of PABPC1 in GC tissues and normal gastric tissues were initially compared via bioinformatics analysis. Immunohistochemical staining was accomplished to assess the expression of PABPC1 in the included GC patients. Then the impacts of PABPC1 expression on survival of GC patients were evaluated by Cox regression and Kaplan-Meier analyses. Results: The expression levels of PABPC1 in gastric tissues were significantly higher than those in normal gastric tissues (paired, p = 0.002; unpaired, p = 3.60e-9). By Kaplan-Meier, it was demonstrated that high expression of PABPC1 was significantly associated with worse overall and disease-free survival. Furthermore, high PABPC1 expression was demonstrated to be an independent predictive factor for both overall (p = 0.013; hazard ratio = 2.058; 95% CI: 1.162-3.644) and disease-free (p = 0.018; hazard ratio = 2.284; 95% CI: 1.153-4.524) survival. Conclusion: PABPC1 is a potential prognostic biomarker for GC patients.
Collapse
Affiliation(s)
- Tailai An
- Center of Digestive Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China.,Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080,China
| | - Lingna Deng
- Department of Pathology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong518107, China
| | - Yan Wang
- Department of Radiology, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, China
| | - Zheng Yang
- Department of Hepatobiliary Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, China
| | - Cuicui Chai
- Department of Hepatobiliary Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, China
| | - Jun Ouyang
- Center of Digestive Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China.,Department of Pathology, Qingyuan People's Hospital, Qingyuan, Guangdong, 511518, China; Center of Scientific Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| | - Xiaofang Lu
- Department of Hepatobiliary Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong 518020, China
| | - Changhua Zhang
- Center of Digestive Diseases, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518107, China
| |
Collapse
|
20
|
Gutiontov S, Pitroda S, Weichselbaum R. The Spectrum of Metastasis: An Opportunity for Cure? Semin Radiat Oncol 2021; 31:174-179. [PMID: 34090643 DOI: 10.1016/j.semradonc.2021.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this review, we outline the clinical and biologic evidence supporting the existence of an oligometastatic state. We first discuss the surgical and radiotherapeutic data that demonstrate clear benefits to cancer-specific outcomes with local ablative therapy in subsets of patients with metastatic disease. We then delve into the evolving preclinical and translational studies already beginning to define the biology of oligometastasis, with a specific focus on the genetics, epigenetics, and immunologic aspects of oligometastatic disease. We conclude by highlighting the importance of focusing significant effort as a research community on developing an integrated clinical-molecular classification of metastatic disease to personalize treatment for patients with potentially curable oligometastatic disease.
Collapse
Affiliation(s)
- Stanley Gutiontov
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago IL
| | - Sean Pitroda
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago IL
| | - Ralph Weichselbaum
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago IL.
| |
Collapse
|
21
|
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) has been recognized as a unique, yet common, clinical entity over the past 2-3 decades. Numerous retrospective series and early phase single arm trials have demonstrated the efficacy and safety of aggressive approaches in select patients. In addition, results from recent randomized trials have demonstrated potential benefits of radiation therapy and surgery as a form of local ablative therapy (LAT) in prolonging disease-free survival and overall survival. However, more questions remain given the limitation of existing clinical evidence and the lack of well validated biomarkers. Advances in late stage randomized trials with biological correlatives may further clarify the role of LAT to assist with clinical decision making in treating patients with oligometastatic NSCLC. In this review, we discuss the clinical and biologic data surrounding patient selection for LAT in oligometastatic NSCLC, as well as future directions in prospective and translational studies.
Collapse
Affiliation(s)
- Xingzhe Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Puneeth Iyengar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
22
|
Zelefsky MJ, Yamada Y, Greco C, Lis E, Schöder H, Lobaugh S, Zhang Z, Braunstein S, Bilsky MH, Powell SN, Kolesnick R, Fuks Z. Phase 3 Multi-Center, Prospective, Randomized Trial Comparing Single-Dose 24 Gy Radiation Therapy to a 3-Fraction SBRT Regimen in the Treatment of Oligometastatic Cancer. Int J Radiat Oncol Biol Phys 2021; 110:672-679. [PMID: 33422612 PMCID: PMC9472455 DOI: 10.1016/j.ijrobp.2021.01.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This prospective phase 3 randomized trial was designed to test whether ultra high single-dose radiation therapy (24 Gy SDRT) improves local control of oligometastatic lesions compared to a standard hypofractionated stereotactic body radiation therapy regimen (3 × 9 Gy SBRT). The secondary endpoint was to assess the associated toxicity and the impact of ablation on clinical patterns of metastatic progression. METHODS AND MATERIALS Between November 2010 and September 2015, 117 patients with 154 oligometastatic lesions (≤5/patient) were randomized in a 1:1 ratio to receive 24 Gy SDRT or 3 × 9 Gy SBRT. Local control within the irradiated field and the state of metastatic spread were assessed by periodic whole-body positron emission tomography/computed tomography and/or magnetic resonance imaging. Median follow-up was 52 months. RESULTS A total of 59 patients with 77 lesions were randomized to 24 Gy SDRT and 58 patients with 77 lesions to 3 × 9 Gy SBRT. The cumulative incidence of local recurrence for SDRT-treated lesions was 2.7% (95% confidence interval [CI], 0%-6.5%) and 5.8% (95% CI, 0.2%-11.5%) at years 2 and 3, respectively, compared with 9.1% (95% CI, 2.6%-15.6%) and 22% (95% CI, 11.9%-32.1%) for SBRT-treated lesions (P = .0048). The 2- and 3-year cumulative incidences of distant metastatic progression in the SDRT patients were 5.3% (95% CI, 0%-11.1%), compared with 10.7% (95% CI, 2.5%-18.8%) and 22.5% (95% CI, 11.1%-33.9%), respectively, for the SBRT patients (P = .010). No differences in toxicity were observed. CONCLUSIONS The study confirms SDRT as a superior ablative treatment, indicating that effective ablation of oligometastatic lesions is associated with significant mitigation of distant metastatic progression.
Collapse
Affiliation(s)
- Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Carlo Greco
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon Portugal
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Heiko Schöder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Steve Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Mark H. Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Richard Kolesnick
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Zvi Fuks
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, N.Y
| |
Collapse
|
23
|
Scarborough JA, Tom MC, Kattan MW, Scott JG. Revisiting a Null Hypothesis: Exploring the Parameters of Oligometastasis Treatment. Int J Radiat Oncol Biol Phys 2021; 110:371-381. [PMID: 33484786 PMCID: PMC8122026 DOI: 10.1016/j.ijrobp.2020.12.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE In the treatment of patients with metastatic cancer, the current paradigm states that metastasis-directed therapy does not prolong life. This paradigm forms the basis of clinical trial null hypotheses, where trials are built to test the null hypothesis that patients garner no overall survival benefit from targeting metastatic lesions. However, with advancing imaging technology and increasingly precise techniques for targeting lesions, a much larger proportion of metastatic disease can be treated. As a result, the life-extending benefit of targeting metastatic disease is becoming increasingly clear. METHODS AND MATERIALS In this work, we suggest shifting this qualitative null hypothesis and describe a mathematical model that can be used to frame a new, quantitative null. We begin with a very simple formulation of tumor growth, an exponential function, and illustrate how the same intervention (removing a given number of cells from the tumor) at different times affects survival. Additionally, we postulate where recent clinical trials fit into this parameter space and discuss the implications of clinical trial design in changing these quantitative parameters. RESULTS Our model shows that although any amount of cell kill will extend survival, in many cases the extent is so small as to be unnoticeable in a clinical context or is outweighed by factors related to toxicity and treatment time. CONCLUSIONS Recasting the null in these quantitative terms will allow trialists to design trials specifically to increase understanding of the circumstances (patient selection, disease burden, tumor growth kinetics) that can lead to improved overall survival when targeting metastatic lesions, rather than whether targeting metastases extends survival for patients with (oligo-) metastatic disease.
Collapse
Affiliation(s)
- Jessica A Scarborough
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, Ohio; Systems Biology and Bioinformatics Program, Department of Nutrition, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Martin C Tom
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jacob G Scott
- Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, Ohio; Systems Biology and Bioinformatics Program, Department of Nutrition, Case Western Reserve School of Medicine, Cleveland, Ohio; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
24
|
Abstract
Oligometastasis represents an intermediate disease stage between localized and widely metastatic cancer. Efficient identification of patients with oligometastasis remains a barrier for accrual on clinical trials of oligometastasis-directed therapy. Here we review the prospect of circulating tumor DNA-based monitoring to promote sensitive, specific, and cost-efficient detection of cancer recurrence during posttreatment surveillance. Thus, an impetus for the development and implementation of clinical-grade circulating tumor DNA assays should be for the positive impact they will have on clinical investigations of oligometastasis-directed therapy.
Collapse
Affiliation(s)
- David Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Bhishamjit S. Chera
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gaorav P. Gupta
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
25
|
Abstract
Historical theories of metastasis have been informed by the seed and soil hypothesis, the Halsteadian paradigm proposing an orderly spread from local to distant sites, and the presumption that cancer is an inherently systemic process even in the earliest cases. The more contemporary spectrum theory now suggests that the propensity for distant spread exists along a continuum of metastatic virulence. Tumors with limited metastatic potential represent one subset along this spectrum that could potentially be cured with local ablative therapy. Integrating clinical and molecular features to biologically inform the classification of not only oligometastatic or oligoprogressive disease but also the entire metastatic spectrum holds great promise to improve prognostication and inform clinical decision making. To this end, the inclusion of molecular correlative studies and biospecimen collection on prospective protocols is imperative.
Collapse
|
26
|
Gutiontov SI, Pitroda SP, Weichselbaum RR. Oligometastasis: Past, Present, Future. Int J Radiat Oncol Biol Phys 2021; 108:530-538. [PMID: 32976785 DOI: 10.1016/j.ijrobp.2020.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the oligometastatic state, with a focus on its current and future relevance within the field of radiation therapy. We first outline the scope of the problem and the evolving understanding of metastatic disease existing along a spectrum. We then transition to a discussion of the clinical data that led to the formulation of the oligometastatic hypothesis, delving in some detail into the clinical factors associated with improved outcomes in the setting of local therapy-whether surgical or radiotherapeutic. In particular, we highlight the marked limitations of using clinical criteria alone to determine the absence or presence of true extracranial oligometastatic disease. After this, we briefly discuss the radiation therapy literature that has recently demonstrated benefits in cancer-specific outcomes with ablative treatment of oligometastatic disease. We emphasize data in the setting of non-small cell lung cancer and prostate cancer and briefly discuss the importance of our enhanced ability to detect occult metastatic disease with improved imaging technologies. After noting that resulted and ongoing prospective trials of ablative radiation therapy use the most rudimentary of oligometastatic classifiers-number of metastases-as their inclusion criteria, we transition to our core argument: a growing body of preclinical and translational work aims to refine the definition of oligometastatic disease using molecular features. We address genomic, epigenetic, and immunologic features that have, across histology, demonstrated an improved ability to prognosticate when combined with classic clinical correlates of oligometastatic disease. We also discuss studies that suggest particular molecular targets which, when manipulated for therapeutic purposes, have the potential to revert the polymetastatic phenotype to the oligometastatic one. We conclude with what we believe are the repercussions of this work for radiation therapy trials and clinical practice, and the importance of enriching and supporting these inquiries for the future of our field.
Collapse
Affiliation(s)
- Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Sean P Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
| |
Collapse
|
27
|
Cytoreduction and the Optimization Of Immune Checkpoint Inhibition with Radiation Therapy. Int J Radiat Oncol Biol Phys 2021; 108:17-26. [PMID: 32819613 DOI: 10.1016/j.ijrobp.2019.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022]
|
28
|
Gomez DR, Yang TJ, Tsai CJ. Emerging Paradigm of Consolidative Thoracic Radiotherapy in Oligometastatic NSCLC. Semin Radiat Oncol 2021; 31:120-123. [PMID: 33610268 DOI: 10.1016/j.semradonc.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The concept of oligometastatic disease has evolved substantially over the past decade. During this time, there has been a transition from retrospective and single-arm prospective studies to randomized evidence suggesting a benefit of local consolidative therapy (LCT) in the setting of limited metastatic non-small cell lung cancer. These trials had constraints and were thus limited in the strength of their conclusions, but led to several other ongoing randomized trials examining the role of LCT. These studies span various disease states (synchronous oligometastatic vs oligoprogressive), the scope of histologies included, and in how they define oligometastases. In addition, parallel biologic work is attempting to integrate relevant biomarkers and molecular classifications, with the ultimate goal of more precisely defining oligometastases and triaging patients to appropriate care. Finally, consensus guidelines have been initiated that provide a framework for designing future studies and for maintaining consistency across analyses that will facilitate the interpretation of results. This review describes the prior randomized data, the limitations therein, and future directions of clinical and preclinical studies that highlight the emerging paradigms for treatment of this select patient cohort.
Collapse
Affiliation(s)
- Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
29
|
Wang Z, Zhou L, Wang Y, Peng Q, Li H, Zhang X, Su Z, Song J, Sun Q, Sayed S, Liu S, Lu D. The CK1δ/ε-AES axis regulates tumorigenesis and metastasis in colorectal cancer. Am J Cancer Res 2021; 11:4421-4435. [PMID: 33754069 PMCID: PMC7977458 DOI: 10.7150/thno.53901] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Amino-terminal enhancer of split (AES) has been identified as a tumor and metastasis suppressor in some cancers including colorectal cancer (CRC), but very little is known about the regulation of AES expression. Methods: Bioinformatics analysis was used to investigate the expression patterns of AES, CK1δ and CK1ε. The co-immunoprecipitation, GST pull-down, Western Blot, real-time PCR and immunohistochemistry were performed to study the mechanism underlying the regulation of AES expression by CK1δ/ε. The biological function was assessed by in vitro colony formation, transwell, sphere formation, tumor organoids, in vivo tumor metastasis model and patient-derived colorectal tumor xenografts (PDTX) model. Results: A strong inverse relationship was observed between the expression of AES and the expression of CK1δ/ε. Mechanically, AES could interact with CK1δ/ε and SKP2 using its Q domain. SKP2 mediated the ubiquitination and degradation of AES in a CK1δ/ε-dependent manner. CK1δ/ε phosphorylated AES at Ser121 and accelerated the SKP2-mediated ubiquitination and degradation of AES. In colon cancer cells, CK1δ/ε antagonized the effect of wild-type AES but not that of its mutant (S121A) on Wnt and Notch signaling, leading to an increase in the expression of Wnt target genes and Notch target genes. By downregulating the expression of AES, CK1δ/ε enhanced anchorage-independent growth, migration, invasion and sphere formation in colon cancer cells. CK1δ/ε also promoted the growth of APCmin/+ colorectal tumor organoids and liver metastasis in colon cancer mouse models through the regulation of AES degradation. Furthermore, CK1 inhibitor SR3029 treatment suppressed tumor growth via stabilizing AES in APCmin/+ colorectal tumor organoids and patient-derived colorectal tumor xenografts (PDTX). Conclusions: Our results revealed that the CK1δ/ε-AES axis is important for CRC tumorigenesis and metastasis, and targeted inhibition of this axis may be a potential therapeutic strategy for CRC.
Collapse
|
30
|
Corradini S, Niyazi M, Verellen D, Valentini V, Walsh S, Grosu AL, Lauber K, Giaccia A, Unger K, Debus J, Pieters BR, Guckenberger M, Senan S, Budach W, Rad R, Mayerle J, Belka C. X-change symposium: status and future of modern radiation oncology-from technology to biology. Radiat Oncol 2021; 16:27. [PMID: 33541387 PMCID: PMC7863262 DOI: 10.1186/s13014-021-01758-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Future radiation oncology encompasses a broad spectrum of topics ranging from modern clinical trial design to treatment and imaging technology and biology. In more detail, the application of hybrid MRI devices in modern image-guided radiotherapy; the emerging field of radiomics; the role of molecular imaging using positron emission tomography and its integration into clinical routine; radiation biology with its future perspectives, the role of molecular signatures in prognostic modelling; as well as special treatment modalities such as brachytherapy or proton beam therapy are areas of rapid development. More clinically, radiation oncology will certainly find an important role in the management of oligometastasis. The treatment spectrum will also be widened by the rational integration of modern systemic targeted or immune therapies into multimodal treatment strategies. All these developments will require a concise rethinking of clinical trial design. This article reviews the current status and the potential developments in the field of radiation oncology as discussed by a panel of European and international experts sharing their vision during the "X-Change" symposium, held in July 2019 in Munich (Germany).
Collapse
Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Dirk Verellen
- Department of Radiotherapy, Iridium Network, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo Valentini
- Department of Radiation Oncology and Hematology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | | | - Anca-L Grosu
- Department of Radiation Oncology, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Amato Giaccia
- Division of Radiation and Cancer Biology, Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Kristian Unger
- Integrative Biology Group, Helmholtz Zentrum Munich, Munich, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Roland Rad
- Center for Translational Cancer Research (TranslaTUM), TU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, University Hospital, LMU, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
31
|
Nagao A, Noie T, Horiuch H, Yamada H, Momiyama M, Nakajima K, Satou S, Satodate H, Nara S, Harihara Y. Long-term survival after pancreatic metastasis resection from breast cancer: a systematic literature review. Surg Case Rep 2021; 7:39. [PMID: 33534098 PMCID: PMC7859131 DOI: 10.1186/s40792-021-01124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patients with advanced-stage breast cancer often demonstrate pancreatic metastases. However, pancreatic metastases resection from breast cancer has been rarely performed, with only 20 cases having been reported to date. Case presentation A 49-year-old woman presented to our hospital in September 2003 with complaints of uncontrollable oozing from her left breast tumor. Computed tomography revealed a left breast tumor approximately 9.3 cm in diameter as well as heterogeneously enhanced solid mass lesions with necrotic foci in the pancreatic tail and body, up to 6.2 cm, which were radiologically diagnosed as pancreatic metastases from breast cancer. An emergent left simple mastectomy was performed to control bleeding. After epirubicin and cyclophosphamide hydrate treatment failed to improve her condition, the pancreatic metastases responded to weekly paclitaxel treatment, but eventually regrew. The patient underwent distal pancreatectomy with splenectomy, left adrenalectomy, partial stomach resection, and paraaortic lymph nodes excision in December 2004 after no other metastasis was confirmed. Furthermore, she received radiation therapy for left parasternal lymph node metastasis 6 months later. The patient recovered well. Consequently, she has no evidence of disease > 15 years after pancreatectomy. Conclusions This is the first reported case of pancreatectomy for pancreatic metastases from breast cancer, which was simultaneously diagnosed. Patients with no metastasis other than resectable pancreatic metastases and breast cancer and who possess some sensitivity for chemotherapy may benefit from pancreatectomy.
Collapse
Affiliation(s)
- Atsuki Nagao
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Tamaki Noie
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Hajime Horiuch
- Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Haruyasu Yamada
- Department of Radiology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masashi Momiyama
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Kentaro Nakajima
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Shouichi Satou
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hitoshi Satodate
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Satoshi Nara
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Yasushi Harihara
- Department of Surgery, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| |
Collapse
|
32
|
Rim CH, Shin IS, Park S, Lee HY. Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review. NPJ Precis Oncol 2021; 5:2. [PMID: 33479481 PMCID: PMC7820397 DOI: 10.1038/s41698-020-00141-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/01/2020] [Indexed: 01/29/2023] Open
Abstract
We conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.
Collapse
Affiliation(s)
- Chai Hong Rim
- grid.222754.40000 0001 0840 2678Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
| | - In-Soo Shin
- grid.255168.d0000 0001 0671 5021Graduate school of Education, Dongguk University, Seoul, Korea
| | - Sunmin Park
- grid.222754.40000 0001 0840 2678Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
| | - Hye Yoon Lee
- grid.222754.40000 0001 0840 2678Department of General Surgery, Ansan Hospital, Korea University Medical College, Ansan, Gyeonggi-do Republic of Korea
| |
Collapse
|
33
|
Yu JB, Brock KK, Campbell AM, Chen AB, Diaz R, Escorcia FE, Gupta G, Hrinivich WT, Joseph S, Korpics M, Onderdonk BE, Pandit-Taskar N, Wood BJ, Woodward WA. Proceedings of the ASTRO-RSNA Oligometastatic Disease Research Workshop. Int J Radiat Oncol Biol Phys 2020; 108:539-545. [PMID: 32434040 DOI: 10.1016/j.ijrobp.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE On June 13 to 14, 2019, the American Society for Radiation Oncology and the Radiological Society of North America convened a workshop on the treatment of oligometastatic disease in Washington, DC. The workshop was initiated for several reasons. First, oligometastatic disease is of increasing academic and community interest and has been identified by the American Society for Radiation Oncology membership as a top research priority. Second, emerging imaging and diagnostic technologies are more readily defining and detecting oligometastatic disease, making contemporary discussion of oligometastatic disease especially relevant. Third, radiosurgery and radiation in general are theorized to be ideal noninvasive therapy for the treatment of oligometastatic disease. Finally, innovations in targeted therapy and immune therapy have the potential to reverse widely disseminating disease into an oligometastatic state. METHODS AND MATERIALS The workshop was organized into 2 keynote addresses, 6 scientific sessions, and 3 group discussions during an end-of-workshop breakout session. New scientific work was presented in the form of 4 oral presentations and a poster session. Workshop participants were charged with attempting to answer 3 critical questions: (1) Can we refine the clinical and biological definitions of oligometastatic disease; (2) how can we better treat oligometastatic disease; and (3) what clinical trials are needed? RESULTS Here, we present the proceedings of the workshop. CONCLUSIONS The clinical implications of improved treatment of oligometastatic disease are enormous and immediate. Radiation oncology and diagnostic radiology should rightly be at the forefront of the characterization and treatment of oligometastatic disease. Focused effort is required so that we can translate current efforts of large numbers of studies with few patients to larger studies of larger impact.
Collapse
Affiliation(s)
- James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| | - Kristy K Brock
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Allison M Campbell
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Aileen B Chen
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Roberto Diaz
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Gaorav Gupta
- Department of Radiation Oncology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - William T Hrinivich
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Sabrina Joseph
- American Society for Radiation Oncology, Arlington, Virginia
| | - Mark Korpics
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Wendy A Woodward
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
34
|
Schadde E, Grunhagen DJ, Verhoef C, Krzywon L, Metrakos P. Limitations in resectability of colorectal liver metastases 2020 - A systematic approach for clinicians and patients. Semin Cancer Biol 2020; 71:10-20. [PMID: 32980499 DOI: 10.1016/j.semcancer.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
Colorectal liver metastases (CRLM) affect over 50 % of all patients with colorectal cancer, which is the second leading cause of cancer in the western world. Resection of CRLM may provide cure and improves survival over chemotherapy alone. However, resectability of CLRM has to be decided in multidisciplinary tumor boards and is based on oncological factors, technical factors and patient factors. The advances of chemotherapy lead to the abolition of contraindications to resection in favor of technical resectability, but somatic mutations and molecular subtyping may improve selection of patients for resection in the future. Technical factors center around anatomy of the lesions, volume of the remnant liver and quality of the liver parenchymal. Multiple strategies have been developed to overcome volume limitations and they are reviewed here. The least investigated topic is how to select the right patients among an elderly and frail patient population for the large variety of technical options specifically for bi-lobar CRLM to keep 90-day mortality as low as possible. The review is an overview over the current state-of-the art and a systematic guide to the topic of resectability of CRLM for both clinicians and patients.
Collapse
Affiliation(s)
- Erik Schadde
- Division of Surgical Oncology and Division of Transplant Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, USA; Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland.
| | - Dirk J Grunhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | |
Collapse
|
35
|
Chierici M, Bussola N, Marcolini A, Francescatto M, Zandonà A, Trastulla L, Agostinelli C, Jurman G, Furlanello C. Integrative Network Fusion: A Multi-Omics Approach in Molecular Profiling. Front Oncol 2020; 10:1065. [PMID: 32714870 PMCID: PMC7340129 DOI: 10.3389/fonc.2020.01065] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
Recent technological advances and international efforts, such as The Cancer Genome Atlas (TCGA), have made available several pan-cancer datasets encompassing multiple omics layers with detailed clinical information in large collection of samples. The need has thus arisen for the development of computational methods aimed at improving cancer subtyping and biomarker identification from multi-modal data. Here we apply the Integrative Network Fusion (INF) pipeline, which combines multiple omics layers exploiting Similarity Network Fusion (SNF) within a machine learning predictive framework. INF includes a feature ranking scheme (rSNF) on SNF-integrated features, used by a classifier over juxtaposed multi-omics features (juXT). In particular, we show instances of INF implementing Random Forest (RF) and linear Support Vector Machine (LSVM) as the classifier, and two baseline RF and LSVM models are also trained on juXT. A compact RF model, called rSNFi, trained on the intersection of top-ranked biomarkers from the two approaches juXT and rSNF is finally derived. All the classifiers are run in a 10x5-fold cross-validation schema to warrant reproducibility, following the guidelines for an unbiased Data Analysis Plan by the US FDA-led initiatives MAQC/SEQC. INF is demonstrated on four classification tasks on three multi-modal TCGA oncogenomics datasets. Gene expression, protein expression and copy number variants are used to predict estrogen receptor status (BRCA-ER, N = 381) and breast invasive carcinoma subtypes (BRCA-subtypes, N = 305), while gene expression, miRNA expression and methylation data is used as predictor layers for acute myeloid leukemia and renal clear cell carcinoma survival (AML-OS, N = 157; KIRC-OS, N = 181). In test, INF achieved similar Matthews Correlation Coefficient (MCC) values and 97% to 83% smaller feature sizes (FS), compared with juXT for BRCA-ER (MCC: 0.83 vs. 0.80; FS: 56 vs. 1801) and BRCA-subtypes (0.84 vs. 0.80; 302 vs. 1801), improving KIRC-OS performance (0.38 vs. 0.31; 111 vs. 2319). INF predictions are generally more accurate in test than one-dimensional omics models, with smaller signatures too, where transcriptomics consistently play the leading role. Overall, the INF framework effectively integrates multiple data levels in oncogenomics classification tasks, improving over the performance of single layers alone and naive juxtaposition, and provides compact signature sizes.
Collapse
Affiliation(s)
| | - Nicole Bussola
- Fondazione Bruno Kessler, Trento, Italy
- University of Trento, Trento, Italy
| | | | - Margherita Francescatto
- Fondazione Bruno Kessler, Trento, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | | | | | | | | |
Collapse
|
36
|
Valentini V, Boldrini L, Mariani S, Massaccesi M. Role of radiation oncology in modern multidisciplinary cancer treatment. Mol Oncol 2020; 14:1431-1441. [PMID: 32418368 PMCID: PMC7332217 DOI: 10.1002/1878-0261.12712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer care is moving from a disease‐focused management toward a patient‐centered tailored approach. Multidisciplinary management that aims to define individual, optimal treatment strategies through shared decision making between healthcare professionals and patient is a fundamental aspect of high‐quality cancer care and often includes radiation oncology. Advances in technology and radiobiological research allow to deliver ever more tailored radiation treatments in an ever easier and faster way, thus improving the efficacy, safety, and accessibility of radiation therapy. While these changes are improving quality of cancer care, they are also enormously increasing complexity of decision making, thus challenging the ability to deliver quality affordable cancer care. In this review, we provide an updated outline of the role of radiation oncology in the modern multidisciplinary treatment of cancer. Particularly, we focus on the way some developments in key areas of cancer management are challenging multidisciplinary cancer care in the different clinical settings of early, locally advanced, and metastatic disease, thus highlighting some priority areas of research.
Collapse
Affiliation(s)
- Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Silvia Mariani
- Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| |
Collapse
|
37
|
Galmiche A, Saidak Z, Bouaoud J, Mirghani H, Page C, Dakpé S, Clatot F. Genomics and precision surgery for head and neck squamous cell carcinoma. Cancer Lett 2020; 481:45-54. [PMID: 32272147 DOI: 10.1016/j.canlet.2020.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022]
Abstract
The identification of the biological determinants that shape the response of tumors to medical therapies offers perspectives for better patient stratification and therapeutic targeting. Here, we discuss how genomics could help to improve the surgical treatment of head and neck squamous cell carcinoma (HNSCC). We examine the potential use of genomic analyses for: i) refining and standardizing the indications for surgery, ii) the choice of surgical procedure, and iii) the follow-up of patients with resected tumors. We highlight the studies that used genomics to explore the contribution of tumor biology to the outcome of surgery. We discuss the important developments that are challenging current surgical practice in HNSCC, such as neoadjuvant immunotherapy and the analysis of circulating DNA. Genomic analyses provide practical tools that could help improve the pathological diagnosis and staging of HNSCC, and increase the appreciation of the importance of tumor biology in the outcome of surgery. Identification of biomarkers will likely contribute to a move toward precision surgery of HNSCC, i.e. the personalization of surgical practice based on tumor biology.
Collapse
Affiliation(s)
- Antoine Galmiche
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Biochemistry, Centre de Biologie Humaine, CHU, Amiens, France.
| | - Zuzana Saidak
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Molecular Oncobiology, Centre de Biologie Humaine, CHU, Amiens, France
| | - Jebrane Bouaoud
- Department of Maxillofacial Surgery and Stomatology, Pitié Salpétrière Hospital, Pierre et Marie Curie University Paris 6, Sorbonne Paris Cité, Paris, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Cyril Page
- Department of Otorhinolaryngology, CHU, Amiens, France
| | - Stéphanie Dakpé
- EA7516 « CHIMERE », Université de Picardie Jules Verne, Amiens, France; Department of Maxillofacial Surgery, CHU, Amiens, France
| | - Florian Clatot
- Centre Henri Becquerel, Rouen, France; INSERM U1245, IRON Team, Rouen, France
| |
Collapse
|
38
|
Tang C, Lee WC, Reuben A, Chang L, Tran H, Little L, Gumbs C, Wargo J, Futreal A, Liao Z, Xia X, Yi X, Swisher SG, Heymach JV, Gomez D, Zhang J. Immune and Circulating Tumor DNA Profiling After Radiation Treatment for Oligometastatic Non-Small Cell Lung Cancer: Translational Correlatives from a Mature Randomized Phase II Trial. Int J Radiat Oncol Biol Phys 2020; 106:349-357. [DOI: 10.1016/j.ijrobp.2019.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022]
|
39
|
Onderdonk BE, Gutiontov SI, Chmura SJ. The Evolution (and Future) of Stereotactic Body Radiotherapy in the Treatment of Oligometastatic Disease. Hematol Oncol Clin North Am 2020; 34:307-320. [DOI: 10.1016/j.hoc.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
40
|
Farias VDA, Tovar I, del Moral R, O'Valle F, Expósito J, Oliver FJ, Ruiz de Almodóvar JM. Enhancing the Bystander and Abscopal Effects to Improve Radiotherapy Outcomes. Front Oncol 2020; 9:1381. [PMID: 31970082 PMCID: PMC6960107 DOI: 10.3389/fonc.2019.01381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022] Open
Abstract
In this paper, we summarize published articles and experiences related to the attempt to improve radiotherapy outcomes and, thus, to personalize the radiation treatment according to the individual characteristics of each patient. The evolution of ideas and the study of successively published data have led us to envisage new biophysical models for the interpretation of tumor and healthy normal tissue response to radiation. In the development of the model, we have shown that when mesenchymal stem cells (MSCs) and radiotherapy are administered simultaneously in experimental radiotherapy on xenotumors implanted in a murine model, the results of the treatment show the existence of a synergic mechanism that is able to enhance the local and systemic actions of the radiation both on the treated tumor and on its possible metastasis. We are convinced that, due to the physical hallmarks that characterize the neoplastic tissues, the physical-chemical tropism of MSCs, and the widespread functions of macromolecules, proteins, and exosomes released from activated MSCs, the combination of radiotherapy plus MSCs used intratumorally has the effect of counteracting the pro-tumorigenic and pro-metastatic signals that contribute to the growth, spread, and resistance of the tumor cells. Therefore, we have concluded that MSCs are appropriate for therapeutic use in a clinical trial for rectal cancer combined with radiotherapy, which we are going to start in the near future.
Collapse
Affiliation(s)
- Virgínea de Araújo Farias
- Centro de Investigación Biomédica, Instituto Universitario de Investigación en Biopatología y Medicina Regenerativa, PTS Granada, Granada, Spain
- CIBERONC (Instituto de Salud Carlos III), Granada, Spain
- Instituto de Parasitología y Biomedicina “López Neyra”, Consejo Superior de Investigaciones Científicas, PTS Granada, Granada, Spain
| | - Isabel Tovar
- Complejo Hospitalario de Granada, Servicio Andaluz de Salud, PTS Granada, Granada, Spain
| | - Rosario del Moral
- Complejo Hospitalario de Granada, Servicio Andaluz de Salud, PTS Granada, Granada, Spain
| | - Francisco O'Valle
- Centro de Investigación Biomédica, Instituto Universitario de Investigación en Biopatología y Medicina Regenerativa, PTS Granada, Granada, Spain
- CIBERONC (Instituto de Salud Carlos III), Granada, Spain
- Instituto de Parasitología y Biomedicina “López Neyra”, Consejo Superior de Investigaciones Científicas, PTS Granada, Granada, Spain
- Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de Granada, PTS Granada, Granada, Spain
| | - José Expósito
- Complejo Hospitalario de Granada, Servicio Andaluz de Salud, PTS Granada, Granada, Spain
| | - Francisco Javier Oliver
- CIBERONC (Instituto de Salud Carlos III), Granada, Spain
- Instituto de Parasitología y Biomedicina “López Neyra”, Consejo Superior de Investigaciones Científicas, PTS Granada, Granada, Spain
| | - José Mariano Ruiz de Almodóvar
- Centro de Investigación Biomédica, Instituto Universitario de Investigación en Biopatología y Medicina Regenerativa, PTS Granada, Granada, Spain
- CIBERONC (Instituto de Salud Carlos III), Granada, Spain
| |
Collapse
|
41
|
Guckenberger M, Lievens Y, Bouma AB, Collette L, Dekker A, deSouza NM, Dingemans AMC, Fournier B, Hurkmans C, Lecouvet FE, Meattini I, Méndez Romero A, Ricardi U, Russell NS, Schanne DH, Scorsetti M, Tombal B, Verellen D, Verfaillie C, Ost P. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol 2020; 21:e18-e28. [PMID: 31908301 DOI: 10.1016/s1470-2045(19)30718-1] [Citation(s) in RCA: 561] [Impact Index Per Article: 140.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Oligometastatic disease has been proposed as an intermediate state between localised and systemically metastasised disease. In the absence of randomised phase 3 trials, early clinical studies show improved survival when radical local therapy is added to standard systemic therapy for oligometastatic disease. However, since no biomarker for the identification of patients with true oligometastatic disease is clinically available, the diagnosis of oligometastatic disease is based solely on imaging findings. A small number of metastases on imaging could represent different clinical scenarios, which are associated with different prognoses and might require different treatment strategies. 20 international experts including 19 members of the European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer OligoCare project developed a comprehensive system for characterisation and classification of oligometastatic disease. We first did a systematic review of the literature to identify inclusion and exclusion criteria of prospective interventional oligometastatic disease clinical trials. Next, we used a Delphi consensus process to select a total of 17 oligometastatic disease characterisation factors that should be assessed in all patients treated with radical local therapy for oligometastatic disease, both within and outside of clinical trials. Using a second round of the Delphi method, we established a decision tree for oligometastatic disease classification together with a nomenclature. We agreed oligometastatic disease as the overall umbrella term. A history of polymetastatic disease before diagnosis of oligometastatic disease was used as the criterion to differentiate between induced oligometastatic disease (previous history of polymetastatic disease) and genuine oligometastatic disease (no history of polymetastatic disease). We further subclassified genuine oligometastatic disease into repeat oligometastatic disease (previous history of oligometastatic disease) and de-novo oligometastatic disease (first time diagnosis of oligometastatic disease). In de-novo oligometastatic disease, we differentiated between synchronous and metachronous oligometastatic disease. We did a final subclassification into oligorecurrence, oligoprogression, and oligopersistence, considering whether oligometastatic disease is diagnosed during a treatment-free interval or during active systemic therapy and whether or not an oligometastatic lesion is progressing on current imaging. This oligometastatic disease classification and nomenclature needs to be prospectively evaluated by the OligoCare study.
Collapse
Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Yolande Lievens
- Department for Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Angelique B Bouma
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Andre Dekker
- Department of Radiation Oncology, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - Anne-Marie C Dingemans
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Beatrice Fournier
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Coen Hurkmans
- Department of Radiotherapy, Catharina Ziekenhuis, Eindhoven, Netherlands
| | - Frédéric E Lecouvet
- Radiology Department, Institut de Recherche Expérimentale et Clinique Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alejandra Méndez Romero
- Department of Radiation Oncology, Erasmus Medical Center, University Medical Center, Rotterdam, Netherlands
| | | | - Nicola S Russell
- Division of Radiotherapy, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Daniel H Schanne
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Louvain-la-Neuve, Brussels, Belgium
| | - Dirk Verellen
- Iridium Kankernetwerk and University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | - Piet Ost
- Department for Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| |
Collapse
|
42
|
Pacheco JM, Moghanaki D. Local consolidative therapy for oligometastatic patients with stage IV non-small cell lung cancer may improve survival, but unanswered questions remain. Transl Lung Cancer Res 2019; 8:S407-S411. [PMID: 32038926 DOI: 10.21037/tlcr.2019.06.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jose M Pacheco
- Division of Medical Oncology, Department of Internal Medicine, University of Colorado Anschutz Cancer Center, Aurora, CO, USA
| | - Drew Moghanaki
- Department of Radiation Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA.,Department of Radiation Oncology, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| |
Collapse
|
43
|
[Relevance of stereotactic ablative radiotherapy in patients with systemic metastasis]. Strahlenther Onkol 2019; 195:943-944. [PMID: 31410510 DOI: 10.1007/s00066-019-01505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|