Oligometastatic disease – a renaissance for surgery?

TL;DR

This paper reviews how combining surgery with systemic therapy can improve outcomes for patients with low metastatic cancer in the esophagus and stomach.

Contribution

The paper highlights the potential of multimodal therapy for oligometastatic disease in esophageal and gastric cancers.

Findings

Multimodal therapy combining surgery and systemic treatment improves prognosis for oligometastatic patients.

Curative-intent treatment is possible for some oligometastatic esophago-gastric junction cancers.

Ongoing trials may support including these strategies in future European guidelines.

Abstract

Half of the patients with esophageal cancer, cancer of the gastro-esophageal junction and gastric cancer present metastasis at the time of diagnosis. In addition, even patients originally thought to be free of metastasis will present metachronous metastasis in the course of the disease. These patients are considered incurable and current standard of care for metastatic esophageal, gastro-esophageal junction and gastric cancers is a systemic therapy without curative intention. However, patients presenting only a low metastatic load are now defined as oligometastatic disease and should benefit from an aggressive, multimodal therapy. We present here a review of recent publications investigating multimodal therapies for oligometastatic disease and showing that a systemic therapy combined with a resection of the primary tumor together with metastasis is associated with a better prognosis than a systemic therapy alone. We also give a precise focus on esophageal squamous cell carcinomas and adenocarcinomas of the gastro-esophageal junction and of the stomach. Interestingly, patients with oligometastatic cancer of the esophago-gastric junction can even be treated in curative intention with such a multimodal therapy as we present here in a short case report. In conclusion, new therapeutic strategies including multimodal approaches for oligometastatic disease have shown promising results in the last years and ongoing randomized prospective trials will provide us the evidence to include them in future European guidelines.

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