Oligometastatic disease - a renaissance for surgery?

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Metastasis at diagnosis is common in esophageal, gastro-esophageal junction, and gastric cancers.
• Metastatic disease is typically treated with palliative systemic therapy.
• Oligometastatic disease, a state of low metastatic burden, presents a potential therapeutic target.

Purpose of the Study:

• To review recent literature on multimodal therapies for oligometastatic esophageal, gastro-esophageal junction, and gastric cancers.
• To evaluate the efficacy of combining systemic therapy with surgical resection for oligometastatic disease.
• To highlight treatment strategies for specific subtypes, including esophageal squamous cell carcinomas and adenocarcinomas.

Main Methods:

• Literature review of recent publications on multimodal treatment for oligometastatic cancers.
• Analysis of studies comparing systemic therapy alone versus multimodal approaches.
• Inclusion of a case report on curative-intent treatment for oligometastatic esophago-gastric junction cancer.

Main Results:

• Multimodal therapy (systemic therapy + resection of primary tumor and metastases) is associated with a better prognosis than systemic therapy alone.
• Specific focus on esophageal squamous cell carcinomas and adenocarcinomas of the gastro-esophageal junction and stomach.
• Curative-intent treatment is possible for select patients with oligometastatic esophago-gastric junction cancer.

Conclusions:

• Multimodal approaches for oligometastatic esophageal, gastro-esophageal junction, and gastric cancers show promising results.
• Further evidence from ongoing randomized trials may support incorporating these strategies into European guidelines.
• Aggressive, multimodal therapy offers improved outcomes for patients with limited metastatic disease.