European clinical practice guidelines for the definition, diagnosis, and treatment of oligometastatic esophagogastric cancer (OMEC-4)

Tiuri E Kroese; Sebastiaan Bronzwaer; Peter S N van Rossum; Sebastian F Schoppman; Pieter R A J Deseyne; Eric van Cutsem; Karin Haustermans; Philippe Nafteux; Melissa Thomas; Radka Obermannova; Hanna R Mortensen; Marianne Nordsmark; Per Pfeiffer; Anneli Elme; Antoine Adenis; Guillaume Piessen; Christiane J Bruns; Florian Lordick; Ines Gockel; Markus Moehler; Cihan Gani; Theodore Liakakos; John V Reynolds; Alessio G Morganti; Riccardo Rosati; Carlo Castoro; Francesco Cellini; Domenico D'Ugo; Franco Roviello; Maria Bencivenga; Giovanni de Manzoni; Mark I van Berge Henegouwen; Maarten C C M Hulshoff; Jolanda van Dieren; Marieke Vollebergh; Johanna W van Sandick; Paul Jeene; Christel Muijs; Marije Slingerland; Francine E M Voncken; Henk Hartgrink; Geert-Jan Creemers; Maurice J C van der Sangen; Grard A P Nieuwenhuijzen; Maaike Berbee; Marcel Verheij; Bas Wijnhoven; Laurens V Beerepoot; Nadia Haj Mohammad; Stella Mook; Jelle P Ruurda; Piotr Kolodziejczyk; Wojciech P Polkowski; Lucjan Wyrwicz; Maria Alsina; Josep Tabernero; Manuel Pera; Tania F Kanonnikoff; Andrés Cervantes; Magnus Nilsson; Stefan Monig; Anna D Wagner; Matthias Guckenberger; Ewen A Griffiths; Elizabeth Smyth; George B Hanna; Sheraz Markar; M Asif Chaudry; Maria A Hawkins; Edward Cheong; Hanneke W M van Laarhoven; Richard van Hillegersberg; OMEC collaborators

doi:10.1016/j.ejca.2024.114062

European clinical practice guidelines for the definition, diagnosis, and treatment of oligometastatic esophagogastric cancer (OMEC-4)

Eur J Cancer. 2024 Apr 16:204:114062. doi: 10.1016/j.ejca.2024.114062. Online ahead of print.

Authors

Tiuri E Kroese¹, Sebastiaan Bronzwaer², Peter S N van Rossum³, Sebastian F Schoppman⁴, Pieter R A J Deseyne⁵, Eric van Cutsem⁶, Karin Haustermans⁷, Philippe Nafteux⁸, Melissa Thomas⁹, Radka Obermannova¹⁰, Hanna R Mortensen¹¹, Marianne Nordsmark¹², Per Pfeiffer¹³, Anneli Elme¹⁴, Antoine Adenis¹⁵, Guillaume Piessen¹⁶, Christiane J Bruns¹⁷, Florian Lordick¹⁸, Ines Gockel¹⁹, Markus Moehler²⁰, Cihan Gani²¹, Theodore Liakakos²², John V Reynolds²³, Alessio G Morganti²⁴, Riccardo Rosati²⁵, Carlo Castoro²⁶, Francesco Cellini²⁷, Domenico D'Ugo²⁸, Franco Roviello²⁹, Maria Bencivenga³⁰, Giovanni de Manzoni³⁰, Mark I van Berge Henegouwen³¹, Maarten C C M Hulshoff³, Jolanda van Dieren³², Marieke Vollebergh³³, Johanna W van Sandick³⁴, Paul Jeene³⁵, Christel Muijs³⁶, Marije Slingerland³⁷, Francine E M Voncken³⁸, Henk Hartgrink³⁹, Geert-Jan Creemers⁴⁰, Maurice J C van der Sangen⁴¹, Grard A P Nieuwenhuijzen⁴², Maaike Berbee⁴³, Marcel Verheij⁴⁴, Bas Wijnhoven⁴⁵, Laurens V Beerepoot⁴⁶, Nadia Haj Mohammad⁴⁷, Stella Mook⁴⁸, Jelle P Ruurda⁴⁹, Piotr Kolodziejczyk⁵⁰, Wojciech P Polkowski⁵¹, Lucjan Wyrwicz⁵², Maria Alsina⁵³, Josep Tabernero⁵⁴, Manuel Pera⁵⁵, Tania F Kanonnikoff⁵⁶, Andrés Cervantes⁵⁶, Magnus Nilsson⁵⁷, Stefan Monig⁵⁸, Anna D Wagner⁵⁹, Matthias Guckenberger⁶⁰, Ewen A Griffiths⁶¹, Elizabeth Smyth⁶², George B Hanna⁶³, Sheraz Markar⁶³, M Asif Chaudry⁶⁴, Maria A Hawkins⁶⁵, Edward Cheong⁶⁶, Hanneke W M van Laarhoven⁶⁷, Richard van Hillegersberg²; OMEC collaborators

Affiliations

¹ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
² Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: r.vanhillegersberg@umcutrecht.nl.
³ Department of Radiation Oncology, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.
⁴ Department of Surgery, Medical University of Vienna, Vienna University, Vienna, Austria.
⁵ Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Department of Medical Oncology, KU Leuven, Leuven University, Leuven, Belgium.
⁷ Department of Radiation Oncology, KU Leuven, Leuven University, Leuven, Belgium.
⁸ Department of Surgery, KU Leuven, Leuven University, Leuven, Belgium.
⁹ Department of Radiation Oncology, AZ Sint-Maarten, Mechelen, Belgium.
¹⁰ Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk, University Brno, Brno, Czech Republic.
¹¹ Danish Center of Particle Therapy, Aarhus University Medical Center, Aarhus University, Aarhus, Denmark.
¹² Department of Oncology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
¹³ Department of Medical Oncology, Odense University Medical Center, University of Odense, Odense, Denmark.
¹⁴ Department of Medical Oncology, Tallinn University Hospital, Tallinn University, Tallinn, Estonia.
¹⁵ Department of Medical Oncology, IRCM, Inserm, Université Montpellier, ICM, Montpellier, France.
¹⁶ Department of Surgery, Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France.
¹⁷ Department of Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁸ Department of Medical Oncology, University Hospital Leipzig, University of Leipzig, Leipzig Germany.
¹⁹ Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany.
²⁰ Department of Medicine, Johannes Gutenberg-University Clinic, University of Mainz, Mainz, Germany.
²¹ Department of Radiation Oncology, University Hospital Tubingen, University of Tubingen, Tubingen, Germany.
²² Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²³ Trinity St James's Cancer Institute, St. James Hospital, Trinity College Dublin, Dublin, Ireland.
²⁴ Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Radiation Oncology, DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy.
²⁵ Department of GI Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Vita-salute University, Milan, Italy.
²⁶ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20072, Italy; Upper GI and General Surgery Division, Department of Surgery IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, Milan 20089, Italy.
²⁷ Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.
²⁸ Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
²⁹ Department of Surgery, Siena University Hospital, University of Siena, Siena, Italy.
³⁰ General and Upper GI Division, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.
³¹ Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
³² Department of Gastrointestinal Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
³³ Department of Medical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
³⁴ Department of Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
³⁵ Department of Radiation Oncology, Radiotherapiegroep, Deventer, the Netherlands.
³⁶ Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³⁷ Department of Medical Oncology, University Medical Center Leiden, University of Leiden, Leiden, the Netherlands.
³⁸ Department of Radiation Oncology, University Medical Center Leiden, University of Leiden, Leiden, the Netherlands.
³⁹ Department of Surgery, University Medical Center Leiden, University of Leiden, Leiden, the Netherlands.
⁴⁰ Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands.
⁴¹ Department of Radiation Oncology, Catharina Cancer Institute, Eindhoven, the Netherlands.
⁴² Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands.
⁴³ Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
⁴⁴ Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴⁵ Department of Surgery, Erasmus University Medical Center, University of Rotterdam, Rotterdam, the Netherlands.
⁴⁶ Department of Medical Oncology, Elisabeth Tweesteden Ziekenhuis Tilburg, the Netherlands.
⁴⁷ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴⁸ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁴⁹ Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁵⁰ Department of Surgery Jagiellonian University Medical College, Krakow, Poland.
⁵¹ Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
⁵² Department of Oncology and Radiotherapy, Maria Skłodowska-Curie Institute, Warsaw, Poland.
⁵³ Department of Medical Oncology, Hospital Universitario de Navarra (HUN) and Navarrabiomed - Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
⁵⁴ Department of Medical Oncology, Vall D'Hebron Hospital Campus and Vall D'Hebron Institute of Oncology (VHIO), CIBERONC, Barcelona, Spain.
⁵⁵ Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
⁵⁶ Department of Medical Oncology, Hospital Clinico Universitario de Valencia, University of Valencia, Incliva Biomedical Research Institute, Valencia, Spain.
⁵⁷ Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁵⁸ Department of Surgery, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
⁵⁹ Department of Oncology, Division of Medical Oncology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.
⁶⁰ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁶¹ Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Birmingham, United Kingdom.
⁶² Department of Oncology, Cambridge University Hospitals, Cambridge University, Cambridge, United Kingdom.
⁶³ Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom, Department of Surgery, Imperial College London, London University, London, United Kingdom.
⁶⁴ Department of GI Cancer & Surgery, The Royal Marsden Hospital & Institute of Cancer Research University of London, London, United Kingdom.
⁶⁵ Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.
⁶⁶ Department of Upper GI and General Surgery, PanAsia Surgery, Singapore.
⁶⁷ Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.

PMID: 38678762
DOI: 10.1016/j.ejca.2024.114062

Abstract

Introduction: The OligoMetastatic Esophagogastric Cancer (OMEC) project aims to provide clinical practice guidelines for the definition, diagnosis, and treatment of esophagogastric oligometastatic disease (OMD).

Methods: Guidelines were developed according to AGREE II and GRADE principles. Guidelines were based on a systematic review (OMEC-1), clinical case discussions (OMEC-2), and a Delphi consensus study (OMEC-3) by 49 European expert centers for esophagogastric cancer. OMEC identified patients for whom the term OMD is considered or could be considered. Disease-free interval (DFI) was defined as the time between primary tumor treatment and detection of OMD.

Results: Moderate to high quality of evidence was found (i.e. 1 randomized and 4 non-randomized phase II trials) resulting in moderate recommendations. OMD is considered in esophagogastric cancer patients with 1 organ with ≤ 3 metastases or 1 involved extra-regional lymph node station. In addition, OMD continues to be considered in patients with OMD without progression in number of metastases after systemic therapy. ¹⁸F-FDG PET/CT imaging is recommended for baseline staging and for restaging after systemic therapy when local treatment is considered. For patients with synchronous OMD or metachronous OMD and a DFI ≤ 2 years, recommended treatment consists of systemic therapy followed by restaging to assess suitability for local treatment. For patients with metachronous OMD and DFI > 2 years, upfront local treatment is additionally recommended.

Discussion: These multidisciplinary European clinical practice guidelines for the uniform definition, diagnosis and treatment of esophagogastric OMD can be used to standardize inclusion criteria in future clinical trials and to reduce variation in treatment.

Keywords: Esophageal cancer; Gastric cancer; Metastasectomy; Metastasis; Oligometastasis; Stereotactic body radiotherapy.