认识到使用转移定向放射治疗(MDRT)治疗寡转移疾病(OMD)的兴趣和证据迅速增加,ESTRO和ASTRO召集了一个委员会,就OMD的定义达成共识,并确定当前证据的差距。
在Medline进行了一项针对治愈性MDRT的系统文献综述,Embase和Cochrane.随后的共识意见,使用Delphi过程,强调了现有文献中的证据现状和局限性。
关于MDRT用于OMD的现有证据主要来自回顾性,单中心系列,患者纳入标准具有显著异质性,OMD的定义,和报告的结果。达成共识,OMD在很大程度上独立于原发性肿瘤,转移位置和无病间隔的存在或长度,支持同步和异时OMD。在缺乏临床数据支持最大数量的转移和器官来定义OMD的情况下,以及经过验证的分子生物标志物,共识支持在所有转移部位进行安全且具有临床疗效的放疗的能力,作为在放疗中定义OMD的最低要求.系统性治疗诱导的OMD被鉴定为OMD的独特状态。高分辨率成像评估和确认OMD至关重要,包括指示时的脑成像。最小共同终点,如无进展生存期和总生存期,本地控制,应报告毒性和生活质量;不常见的终点如推迟全身治疗和费用得到认可.
虽然文献中当前的OMD定义存在显著的异质性,就多个关键问题达成共识。根据现有数据,到目前为止,OMD可以定义为1-5个转移性病变,受控的原发性肿瘤是可选的,但所有转移部位必须安全治疗。在正在进行的试验和报告中,有必要并鼓励一致的定义和报告,以产生进一步的证据来优化患者的益处。
Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for
oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish
consensus regarding definitions of OMD and define gaps in current evidence.
A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent
consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature.
Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, single-centre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported.
Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed.
While significant heterogeneity exists in the current OMD definitions in the literature,
consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1-5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.