Hold the line: Local control strategies in oligoprogressive gynecologic cancers during systemic therapy

Gynecologic malignancies have undergone significant therapeutic advances with the introduction of targeted agents such as bevacizumab and poly(ADP-ribose) polymerase inhibitors (PARPis), immune checkpoint inhibitors, and, more recently, antibody-drug conjugates. These innovations have improved disease control and overall survival for many patients; however, disease progression during systemic therapy remains common and increasingly presents as oligorecurrent or oligoprogressive disease, characterized by limited metastatic sites in the context of otherwise controlled disease. Concurrent advances in locoregional treatments-including stereotactic body radiotherapy, minimally invasive surgery, and image-guided percutaneous ablation-have expanded the feasibility of safely targeting small-volume metastases. These approaches have demonstrated durable local control in selected patients without concurrent systemic therapy and may offer additional benefit when combined with ongoing treatments. Retrospective data, largely derived from ovarian cancer cohorts treated with PARPis, suggest that ablating resistant metastatic clones may enable continuation of otherwise effective ongoing systemic therapy, prolong next-line systemic treatment-free survival (NEST-FS), and preserve quality of life. Emerging evidence also supports the safety of combining locoregional treatments with immune checkpoint inhibitors and targeted therapies other than PARPis; however, data remain limited and heterogeneous, particularly in endometrial and cervical cancers. Key challenges include patient selection, disease and molecular characterization, treatment sequencing, and survival impact. While multidisciplinary decision-making remains crucial, the results of trials assessing the safety and efficacy of combining ongoing systemic therapies with locoregional management strategies are keenly awaited. Future translational research may improve the detection of oligoprogressive disease and help identify patients most likely to benefit from this strategy. This review summarizes current evidence and future directions in the management of oligoprogressive gynecologic cancers, discussing the rationale for locoregional treatment while continuing systemic therapy.