Aim Esophageal cancer (EC) is an aggressive disease associated with poor prognosis due to its metastatic spread. Surgery associated with chemotherapy (CHT)/chemo-radiotherapy represents the only curative treatment, however metastatic EC has not been treated with curative intent until now. Oligometastatic disease is defined as a relatively favorable clinical state, with a concentration metastasis to a single organ. Liver is one of the most common sites of metastasis, however treatment for liver oligometastatic EC (OEC) is still debated and its prognosis remains obscure. The aim of this review is to provide an overview of different treatments for liver OEC with a proposal of a multimodality strategy. Methods Literature search was conducted using PubMed, Embase and Cochrane to identify articles evaluating different treatment strategies for liver OEC. Results Liver OEC has been treated with either palliative therapy or multimodal approach (CHT+surgery/loco-regional therapies). Some small trials reported the benefits of hepatectomy in combination with CHT when applied to patients with low tumor burden (<3 lesions), therefore liver OEC patients should not be necessarily excluded from surgery. An alternative to surgery is represented by loco-regional therapies, including radiofrequency ablation (RFA), microwave ablation (MWA) and stereotactic body radiation therapy (SBRT). These treatments could be proposed to patients with small or non-resectable lesions. However, at present, there are no trials comparing these different treatment modalities. Conclusion In conclusion, we highlighted the need of a definition of treatment protocols and we propose our treatment flow-chart. However, prospective trials are needed to define universally accepted inclusion criteria, outcomes and timing for treatments.
MANAGEMENT OF LIVER OLIGOMETASTATIC ESOPHAGEAL CANCER: REVIEW OF THE CURRENT INDICATIONS AND PROPOSAL FOR A MULTIMODALITY STRATEGY
Procopio F;
2019-01-01
Abstract
Aim Esophageal cancer (EC) is an aggressive disease associated with poor prognosis due to its metastatic spread. Surgery associated with chemotherapy (CHT)/chemo-radiotherapy represents the only curative treatment, however metastatic EC has not been treated with curative intent until now. Oligometastatic disease is defined as a relatively favorable clinical state, with a concentration metastasis to a single organ. Liver is one of the most common sites of metastasis, however treatment for liver oligometastatic EC (OEC) is still debated and its prognosis remains obscure. The aim of this review is to provide an overview of different treatments for liver OEC with a proposal of a multimodality strategy. Methods Literature search was conducted using PubMed, Embase and Cochrane to identify articles evaluating different treatment strategies for liver OEC. Results Liver OEC has been treated with either palliative therapy or multimodal approach (CHT+surgery/loco-regional therapies). Some small trials reported the benefits of hepatectomy in combination with CHT when applied to patients with low tumor burden (<3 lesions), therefore liver OEC patients should not be necessarily excluded from surgery. An alternative to surgery is represented by loco-regional therapies, including radiofrequency ablation (RFA), microwave ablation (MWA) and stereotactic body radiation therapy (SBRT). These treatments could be proposed to patients with small or non-resectable lesions. However, at present, there are no trials comparing these different treatment modalities. Conclusion In conclusion, we highlighted the need of a definition of treatment protocols and we propose our treatment flow-chart. However, prospective trials are needed to define universally accepted inclusion criteria, outcomes and timing for treatments.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
