Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice

Sebastian M. Christ; Minsu Breitenstein; Philip Heesen; Brandon Turner; Urs J. Muehlematter; Kaspar Pohl; Jonas Willmann; Alexander Maurer; Sukhdeep K. Nagpal; Maiwand Ahmadsei; Eugenia Badra Vlaskou; Esmée L. Looman; Astrid E. Heusel; Michael Mayinger; Panagiotis Balermpas; Andreas Wicki; Nicolaus Andratschke; Tracy Balboni; Mai Anh Huynh; Martin Huellner; Matthias Guckenberger

Clinical and Translational Radiation Oncology (Sep 2024)

Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice

Sebastian M. Christ,
Minsu Breitenstein,
Philip Heesen,
Brandon Turner,
Urs J. Muehlematter,
Kaspar Pohl,
Jonas Willmann,
Alexander Maurer,
Sukhdeep K. Nagpal,
Maiwand Ahmadsei,
Eugenia Badra Vlaskou,
Esmée L. Looman,
Astrid E. Heusel,
Michael Mayinger,
Panagiotis Balermpas,
Andreas Wicki,
Nicolaus Andratschke,
Tracy Balboni,
Mai Anh Huynh,
Martin Huellner,
Matthias Guckenberger

Affiliations

Sebastian M. Christ: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland; Corresponding author at: Department of Radiation Oncology, University Hospital & University of Zurich, Rämistrasse 100, 8091 Zurich, CH, Switzerland.
Minsu Breitenstein: Faculty of Medicine, University of Zurich, Zurich, CH, Switzerland
Philip Heesen: Faculty of Medicine, University of Zurich, Zurich, CH, Switzerland
Brandon Turner: Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
Urs J. Muehlematter: Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
Kaspar Pohl: Faculty of Medicine, University of Zurich, Zurich, CH, Switzerland
Jonas Willmann: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Alexander Maurer: Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
Sukhdeep K. Nagpal: Radiotherapy Dept., The Royal Marsden NHS Foundation Trust, London, UK
Maiwand Ahmadsei: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Eugenia Badra Vlaskou: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Esmée L. Looman: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Astrid E. Heusel: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Michael Mayinger: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Panagiotis Balermpas: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Andreas Wicki: Dept. of Medical Oncology & Hematology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Nicolaus Andratschke: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland
Tracy Balboni: Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
Mai Anh Huynh: Dept. of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA
Martin Huellner: Dept. of Nuclear Medicine, University Hospital & University of Zurich, Zurich, CH, Switzerland
Matthias Guckenberger: Dept. of Radiation Oncology, University Hospital & University of Zurich, Zurich, CH, Switzerland

Journal volume & issue: Vol. 48
p. 100838

Abstract

Read online

Aims: Multidisciplinary tumor boards (MDTs) are an integral part of ensuring high-quality, evidence-based and personalized cancer care. In this study, we aimed to evaluate the adherence to and implementation of MDT recommendations in patients with oligometastatic disease (OMD). Methods: We screened all oncologic positron emission tomography (PET) scans conducted at a single comprehensive cancer center in 2020. Patients were included if they had evidence of imaging-based OMD from a solid organ malignancy on the index scans, had their OMD case discussed at an MDT, and were treated and followed up at the same center. A switch away from the MDT-recommended treatment modalities was classified as a major deviation; non-MDT-mandated adjustments to a recommended treatment modality were coded as minor deviation. Clinical data was obtained via chart review; statistical calculations were computed using the R software. Results: After review of PET and/or concurrent brain scans, 787 cases of OMD were identified. Thereof, 347 (44.1 %) cases were discussed at MDT, of which 331 (42.1 %) were therapeutically managed and subsequently followed. The three most commonly recommended therapies were systemic therapy (35.6 %), multimodality treatment including definitive local therapy (17.8 %), and radiotherapy (13.9 %). A major deviation was recorded in 16.3 % of cases (most commonly: none of the MDT-recommended treatment modalities were performed: 19 (35.2 %); not all MDT-planned treatment modalities were performed: 12 (22.2 %); and additional treatment modality was performed: 11 (20.3 %). A minor deviation was found in 1.5 % of cases. On multivariable regression, number of distant metastases (n > 1) was associated with a major deviation (OR: 1.85; 95 % CI, 1.0–3.52). Major deviations were associated with a significantly worse OS (p = 0.0034). Conclusions: Adherence to and implementation of MDT recommendations in OMD patients was generally high (83.7%). Major deviations might be further reduced by more careful and elaborate discussions of OMD patient characteristics s and patient preferences.

Published in Clinical and Translational Radiation Oncology

ISSN: 2405-6308 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/clinical-and-translational-radiation-oncology

About the journal

Abstract

Keywords