Oligometastatic disease

The oligometastatic disease is an intermediate state between locally advanced and disseminated or multimetastatic cancer [1]. It has been based on the number of detectable metastatic lesions in imaging exams, with the threshold varying between 3 and 10 lesions. Singh et al. [2] reported that a number of metastases limited to five lesions developed during follow-up after curative treatment of primary tumor were significantly associated with better 5-year survival (73% vs. 43% of patients with more than five metastases). Therefore, patients with oligometastatic disease are thought to have improved outcomes compared with those with multimetastatic cancer, with greater median survivals [3]. Until there is genomic or proteomic data that provide a biological component for the definition of oligometastatic disease, a clinical diagnosis based on specific cut-offs of the number of metastases (usually up to 5) and involved sites (usually up to 2) is reasonable [4,7]. Relapse may be local or distant. The molecular basis of oligometastases is that they can act like primary tumors and are able to seed and form new metastases [5].
In addition, a distinction is made between synchronous disease (de novo or primary metastases, untreated primary tumor) and metachronous disease (primary tumor previously treated and metastases are encountered during recurrence) [4]. For the definition of oligometastatic disease, these time and onset of metastasis (synchronous [de novo, within 3 months of primary diagnosis] versus metachronous [recurrent]) was also recently defined by the Dutch Oligometastatic Prostate Cancer Working Group [8]. An even more recent update is that of the ESTRO-EORTC consensus [6]:

Recorded at the 2016 World Conference of Lung Cancer (WCLC) of the International Association for the Study of Lung Cancer (IASLC) in Vienna, Austria.

Bibliographic references:

[1] Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995 Jan;13(1):8-10. Available at: https://doi.org/10.1200/JCO.1995.13.1.8.

[2] Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, et al. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol Biol Phys. 2004 Jan 1;58(1):3-10. Available at: https://doi.org/10.1016/S0360-3016(03)01442-1.

[3] Tree AC, Khoo VS, Eeles RA, Ahmed M, Dearnaley DP, Hawkins MA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol. 2013 Jan;14(1):e28-37. Available at: https://doi.org/10.1016/S1470-2045(12)70510-7.

[4] Tosoian JJ, Gorin MA, Ross AE, Pienta KJ, Tran PT, Schaeffer EM. Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol. 2017 Jan;14(1):15-25. Available at: https://doi.org/10.1038/nrurol.2016.175.

[5] Gundem G, Van Loo P, Kremeyer B, Alexandrov LB, Tubio JMC, Papaemmanuil E, et al. The evolutionary history of lethal metastatic prostate cancer. Nature. 2015 Apr 16;520(7547):353-357. Available at: https://doi.org/10.1038/nature14347.

[6] Guckenberger M, Lievens Y, Bouma AB, et al. 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 Jan;21(1):e18-e28. Available at: https://doi.org/10.1016/s1470-2045(19)30718-1.
[7] Login | Mirrors of Medicine [Internet]. Ppcp.mirrorsmed.org. [cited 2019 Oct 13]. Available from: https://ppcp.mirrorsmed.org/assessment/review/gdzhyn8q6tc08wcg0ss8wgk08gcoww8.
[8] Aluwini SS, Mehra N, Lolkema MP, et al. Oligometastatic Prostate Cancer: Results of a Dutch Multidisciplinary Consensus Meeting [published online ahead of print, 2019 Aug 7]. Eur Urol Oncol. 2019;S2588-9311(19)30113-0. Available at: https://doi.org/10.1016/j.euo.2019.07.010.

Oligoprogressive versus oligopersistent

The oligoprogressive phase is a relapsed phase of oligometastatic cancer under a systemic treatment [1]. It «refers to disease progression at a limited number of anatomic sites, with continued response or stable disease at other sites of disease [2].» It can also be related «to patients with stage IV disease who are receiving active systemic therapy that is controlling most of the disease in the body but a small number of sites show disease progression [2].» «Oligoprogression refers to the clinical scenario where a few metastases progress, whereas all other metastases are stable or responding to a systemic therapy strategy. Unlike the oligometastatic state, there can be diffuse metastatic disease, therefore there is no upper limit about how many metastases a patient has. The key point is that with the exception of a few growing tumours, the majority of other tumours are not progressing [3].»

The oligopersistent phase refers to the persistence or resistance but not the progression of the disease to systemic treatment [1].

According to the ESTRO-EORTC consensus [1]:

An oligoprogressive prostate cancer is «a limited number of pelvic or distant recurrent metastases that have arisen or progressed while the patient was receiving systemic therapy, historically androgen deprivation therapy». An oligopersistent prostate cancer is «a limited number of residual pelvic or distant recurrent lesions that persist following an intervention. The term applies to both hormone-sensitive and castrate-resistant prostate cancer patients» [4].

Bibliographic references:

[1] Guckenberger M, Lievens Y, Bouma AB, et al. 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 Jan;21(1):e18-e28. Available at: https://doi.org/10.1016/s1470-2045(19)30718-1.
[2] Kim C, Hoang CD, Kesarwala AH, et al. Role of Local Ablative Therapy in Patients with Oligometastatic and Oligoprogressive Non-Small Cell Lung Cancer. J Thorac Oncol. 2017 Feb;12(2):179-193. Available at: https://doi.org/10.1016/j.jtho.2016.10.012.
[3] Cheung P. Stereotactic body radiotherapy for oligoprogressive cancer. Br J Radiol. 2016 Oct;89(1066):20160251. Available at: https://doi.org/10.1259/bjr.20160251. 

[4] Kucharczyk MJ, So J, Gravis G, et al. A combined biological and clinical rationale for evaluating metastasis directed therapy in the management of oligometastatic prostate cancer. Radiother Oncol. 2020 Nov;152:80-88. Available at: https://doi.org/10.1016/j.radonc.2020.08.011.

Oligorecurrent

The oligorecurrent phase is a relapsed phase of oligometastatic cancer [1]. «The conditions of oligorecurrence has a primary site of cancer controlled, meaning that all gross recurrent or metastatic sites could be treated using local therapy [2].»

«Schema 1 shows one distant metastasis/recurrence with a primary lesion. Schema 2 shows two distant metastases/recurrences with a primary lesion.»

Source: [2].

«Schema 1 shows one distant metastasis/recurrence with a controlled primary lesion. Schema 2 shows two distant metastases/recurrences with a controlled primary lesion. The biggest difference between oligometastases and oligo-recurrences lies in the uncontrolled or controlled primary lesion. Oligo-recurrence requires a controlled primary lesion.»

Source: [2].

According to the ESTRO-EORTC consensus [3]:

An oligorecurrent prostate cancer is «a metachronous hormone-sensitive metastatic prostate cancer with a limited number of metastases, all of which are amenable to intervention» [4].

Bibliographic references:

[1] Alongi F, Mazzola R, Figlia V, Guckenberger M. Stereotactic body radiotherapy for lung oligometastases: Literature review according to PICO criteria. Tumori. 2018 Jun;104(3):148-156. Available at: https://doi.org/10.1177/0300891618766820.

[2] Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol. 2010 Feb;40(2):107-11. Available at: https://doi.org/10.1093/jjco/hyp167.

[3] Guckenberger M, Lievens Y, Bouma AB, et al. 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 Jan;21(1):e18-e28. Available at: https://doi.org/10.1016/s1470-2045(19)30718-1.

[4] Kucharczyk MJ, So J, Gravis G, et al. A combined biological and clinical rationale for evaluating metastasis directed therapy in the management of oligometastatic prostate cancer. Radiother Oncol. 2020 Nov;152:80-88. Available at: https://doi.org/10.1016/j.radonc.2020.08.011.

A video to general practitioners for the detection of cancers of the upper aerodigestive tract:

[French]

Source: Détection précoce des cancers de la cavité buccale - Dépistage et détection précoce. E-cancer.fr. https://www.e-cancer.fr/Professionnels-de-sante/Depistage-et-detection-precoce/Detection-precoce-des-cancers-de-la-cavite-buccale#. Published 2018. Accessed October 17, 2018.

It’s all about statistics:

Source: Carvalho R. Twitter. Twitter.com. https://twitter.com/rcarvalhoonco/status/1045489255445934082?s=03. Published 2018. Accessed October 17, 2018.

Statistics

«The statistics studies how to collect data (How many? In what way?) and how to analyze them to obtain the information that allows answering the questions that we put. It is about producing knowledge through observation and analysis of reality, in an intelligent and objective way. It is the essence of the scientific method.»
«To summarize a set of information from a large dataset, certain quantities are selected which concentrate the most possible information, and through them - can be 5 or 6 points - we can get a fairly accurate idea of the behavior of the data in general. These amounts are normally divided into three groups: tendency (center), scale (or dispersion), and location.»

Bibliographic reference: Grima P. Os segredos da estatística - a certeza absoluta e outras ficções. National Geographic - Edição Especial Matemática. 2018:15.