Local treatment of oligometastatic disease: current role

The presence of distant metastases has long been a predictor of poor outcome in solid cancer. However, in an oncologic situation called oligometastatic disease (OMD), multiple studies have revealed a survival benefit with aggressive treatment of these metastases. Besides surgery and radiation therapy, local thermal therapies have developed into a treatment option for OMD. Most studies concerning local therapy of OMD are available for colorectal cancer, which is therefore the focus of this article. Furthermore, this review gives a basic overview of the most popular ablation techniques for treatment of OMD.

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Influence of age on receipt of chemotherapy for adult Medicaid beneficiaries with metastatic colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9548 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9548-9548

Author(s):

H. D. Klepin ◽

E. Y. Song ◽

A. M. Geiger ◽

J. A. Tooze ◽

K. L. Foley

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Metastatic Colorectal Cancer ◽

Low Income ◽

Care Setting ◽

Academic Medical Center ◽

Local Treatment ◽

Local Therapy ◽

Health Care Setting ◽

Race Ethnicity

9548 Background: Although advances in systemic treatment for metastatic colorectal cancer (CRC) have improved survival, it is unclear if this treatment is administered routinely among vulnerable individuals. Our objective was to describe treatment patterns for low income individuals with metastatic CRC and evaluate the influence of age on delivery of treatment in the context of patient, community, and health care setting characteristics. Methods: Matched North Carolina Cancer Registry and Medicaid claims data were used to identify a cohort of 390 patients with metastatic CRC diagnosed between 1999 and 2002. We assessed the relationship between treatment delivered within one year of diagnosis and characteristics of the patient (age, gender, race/ethnicity, comorbidity), community (percent poverty, percent rural), and health care setting (academic medical center, surgery volume). Treatment delivery was categorized into: 1) receipt of any chemotherapy, 2) local therapy only, and 3) no treatment. We fit a logistic regression model comparing receipt of any chemotherapy to local treatment only and another comparing receipt of any chemotherapy to no treatment. Results: Patients' mean age was 65.1±14.6 years; 56.0% were female and 45.5% were non-white. Only 27.7% received chemotherapy, while 50.3% received local therapy only and 22.0% received no treatment. After adjusting for comorbidity and all other covariates, patients aged <75 years were more likely to receive chemotherapy than patients ≥75 (versus local treatment only, OR=3.2, 95% CI=1.7–6.1; versus no treatment, OR=3.9, 95% CI=1.9–8.3). Absence of significant comorbidity was associated with use of chemotherapy only when compared to those who received no treatment (OR=3.1, 95% CI=1.6–5.9). Race/ethnicity, community, and health care setting characteristics were not associated with treatment. Conclusions: Use of chemotherapy in this low income cohort was low compared to published reports in other populations. Younger age was the only characteristic in this analysis which was consistently associated with receipt of chemotherapy. These results suggest that older low income patients may represent a particularly vulnerable population with regard to treatment disparity. No significant financial relationships to disclose.

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Adjunctive local therapy in metastatic colorectal cancer in an unselected cohort: Improved patient-survival in comparison to systemic therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4096 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4096-4096

Author(s):

Jan Schroeder ◽

Evrim Tasci ◽

Claus Nolte-Ernsting ◽

Peter Michels ◽

Natalie Wetzel ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Lung Metastases ◽

Local Therapy ◽

Distant Metastases ◽

Reference Population ◽

Systemic Treatments ◽

Radiofrequency Therapy ◽

Study Population ◽

Prospective Longitudinal

4096 Background: Patients with distant metastases in colorectal cancer have a poor prognosis and a low overall survival (OS). In addition to systemic treatments and irradiation, the tumor burden can be reduced by loco-regional therapeutics, including microwave ablation (MWA), radiofrequency therapy (RFA) and trans-arterial chemoembolization (TACE) available. To evaluate the benefit of such local therapies, we compared OS of a single-centre study population to a reference population of patients who underwent no loco-regional treatment within the German Tumor Registry Colorectal Cancer (TKK). Methods: The study population consists of a cohort of 51 patients (n = 51) treated loco-regionally in addition to systemic therapy. The patients were recruited in a single cancer centre in Mülheim, Germany during the years 2006 to 2015. A reference population of 788 patients was chosen from a prospective, longitudinal registry of the TKK. Time to event data analysis included the estimation of Kaplan-Meier cumulative survival probabilities and hazard ratios (HR) with corresponding 95% confidence intervals (95% CI) from Cox proportional hazards regression. Results: The median OS was 31.3 months (95% CI 26.8 - 41.6) in the study population, as compared to the reference population, where it was 21.9 months (95% CI 20.1 – 24.6). Patients with liver and lung metastases in the study population had an OS of 41.6 months (95% CI 30.5 – 78.2), the corresponding patients from the reference population 21.7 months (95% CI 16.7 – 24.6). Furthermore, patients in the reference group had a 1.79-fold death-rate, as compared to patients treated with additional loco-regional therapy (HR = 2.02; 95% CI: 1.29-3.16). Conclusions: Additional treatment with loco-regional therapies of distant metastases in patients with metastatic colorectal cancer appears to be associated with improved OS by nearly 10 months compared to systemic treatments only. [Table: see text]

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Survival benefit of repeat local treatment in patients suffering from early recurrence of colorectal cancer liver metastases

Clinical Colorectal Cancer ◽

10.1016/j.clcc.2021.07.007 ◽

2021 ◽

Author(s):

Tessa Hellingman ◽

Babette I. Kuiper ◽

Laurien M. Buffart ◽

Martijn R. Meijerink ◽

Kathelijn S. Versteeg ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastases ◽

Survival Benefit ◽

Local Treatment ◽

Early Recurrence ◽

Colorectal Cancer Liver Metastases

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Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC

Current Oncology ◽

10.3390/curroncol28010059 ◽

2021 ◽

Vol 28 (1) ◽

pp. 593-605

Author(s):

Camille Gauvin ◽

Vimal Krishnan ◽

Imane Kaci ◽

Danh Tran-Thanh ◽

Karine Bédard ◽

...

Keyword(s):

Lung Cancer ◽

Cell Death ◽

Treatment Group ◽

Programmed Cell Death ◽

Prognostic Impact ◽

Aggressive Treatment ◽

Palliative Approach ◽

Oligometastatic Disease ◽

Group A ◽

Group B

Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting.

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Nomogram based on homogeneous and heterogeneous associated factors for predicting distant metastases in patients with colorectal cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02140-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Tianwen Luo ◽

Yutong Wang ◽

Xuefeng Shan ◽

Ye Bai ◽

Chun Huang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lung Metastases ◽

Roc Curves ◽

Distant Metastases ◽

Good Prediction ◽

Operating Characteristics ◽

Good Prediction Performance ◽

Different Types ◽

Associated Risk Factors

Abstract Background The identification of the homogeneous and heterogeneous risk factors for different types of metastases in colorectal cancer (CRC) may shed light on the aetiology and help individualize prophylactic treatment. The present study characterized the incidence differences and identified the homogeneous and heterogeneous risk factors associated with distant metastases in CRC. Methods CRC patients registered in the SEER database between 2010 and 2016 were included in this study. Logistic regression was used to analyse homogeneous and heterogeneous risk factors for the occurrence of different types of metastases. Nomograms were constructed to predict the risk for developing metastases, and the performance was quantitatively assessed using the receiver operating characteristics (ROC) curve and calibration curve. Results A total of 204,595 eligible CRC patients were included in our study, and 17.07% of them had distant metastases. The overall incidences of liver metastases, lung metastases, bone metastases, and brain metastases were 15.34%, 5.22%, 1.26%, and 0.29%, respectively. The incidence of distant metastases differed by age, gender, and the original CRC sites. Poorly differentiated grade, more lymphatic metastasis, higher carcinoembryonic antigen (CEA), and different metastatic organs were all positively associated with four patterns of metastases. In contrast, age, sex, race, insurance status, position, and T stage were heterogeneously associated with metastases. The calibration and ROC curves exhibited good performance for predicting distant metastases. Conclusions The incidence of distant metastases in CRC exhibited distinct differences, and the patients had homogeneous and heterogeneous associated risk factors. Although limited risk factors were included in the present study, the established nomogram showed good prediction performance.

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472 Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Did We Learn from the National Bowel Cancer Audit?

British Journal of Surgery ◽

10.1093/bjs/znab134.558 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Li ◽

S Z Y Ooi ◽

T Woo ◽

P H M Chan

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

External Validation ◽

Distant Metastases ◽

Management Plan ◽

Bowel Cancer ◽

Clinical Factors ◽

Quality Outcomes ◽

Colorectal Cancer Patients

Abstract Aim To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery. Method Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate. Results Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p < 0.05) impact on the length of hospitalisation and 18-month stoma rate. 18-month stoma rate was also significantly associated with 2-year mortality. External validation of the regression model demonstrated the Root-Mean-Square-Error of 0.811 and 4.62 for 18-month stoma rate and 2-year mortality respectively. Conclusions Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.

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Comparison of Cancer Patients to Non-Cancer Patients among COVID-19 Inpatients at a National Level

Cancers ◽

10.3390/cancers13061436 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1436

Author(s):

Alain Bernard ◽

Jonathan Cottenet ◽

Philippe Bonniaud ◽

Lionel Piroth ◽

Patrick Arveux ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Mortality Risk ◽

Hospital Admissions ◽

National Level ◽

Administrative Database ◽

Hospital Death ◽

Solid Cancer ◽

Hematological Cancer ◽

Risk Of Death

(1) Background: Several smaller studies have shown that COVID-19 patients with cancer are at a significantly higher risk of death. Our objective was to compare patients hospitalized for COVID-19 with cancer to those without cancer using national data and to study the effect of cancer on the risk of hospital death and intensive care unit (ICU) admission. (2) Methods: All patients hospitalized in France for COVID-19 in March–April 2020 were included from the French national administrative database, which contains discharge summaries for all hospital admissions in France. Cancer patients were identified within this population. The effect of cancer was estimated with logistic regression, adjusting for age, sex and comorbidities. (3) Results: Among the 89,530 COVID-19 patients, we identified 6201 cancer patients (6.9%). These patients were older and were more likely to be men and to have complications (acute respiratory and kidney failure, venous thrombosis, atrial fibrillation) than those without cancer. In patients with hematological cancer, admission to ICU was significantly more frequent (24.8%) than patients without cancer (16.4%) (p < 0.01). Solid cancer patients without metastasis had a significantly higher mortality risk than patients without cancer (aOR = 1.4 [1.3–1.5]), and the difference was even more marked for metastatic solid cancer patients (aOR = 3.6 [3.2–4.0]). Compared to patients with colorectal cancer, patients with lung cancer, digestive cancer (excluding colorectal cancer) and hematological cancer had a higher mortality risk (aOR = 2.0 [1.6–2.6], 1.6 [1.3–2.1] and 1.4 [1.1–1.8], respectively). (4) Conclusions: This study shows that, in France, patients with COVID-19 and cancer have a two-fold risk of death when compared to COVID-19 patients without cancer. We suggest the need to reorganize facilities to prevent the contamination of patients being treated for cancer, similar to what is already being done in some countries.

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