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<p>In contrast to the diffuse metastatic situation, oligometastatic gastrointestinal (GI) tumors are characterized by metastases that affect only a&#xa0;few organs. While local therapies are established for tumors such as melanoma or breast cancer, the evidence for GI tumors varies. However, the combination of systemic, surgical, and radiotherapeutic approaches shows promising results, particularly in colorectal cancer. The definition and classification of oligometastatic stages is essential for treatment decisions. Synchronous, metachronous, de novo, or treatment-induced oligometastases differ in their biological development and clinical dynamics. Tumor burden is a&#xa0;key prognostic factor. Systemic therapies in the oligometastatic situation serve reduction of the tumor burden as well as biological selection in order to enable local treatment of the primary tumor and/or metastases, be it by resection or radiotherapy. Induction chemotherapy is important to put patients in the best possible condition for local treatments. Immune and targeted therapies expand the options for selected patients, especially in the presence of specific molecular markers, and can achieve very good treatment responses. They have the potential to convert tumor diseases from diffuse metastasis to oligometastasis, whereby the presence of diffuse metastases, especially from upper GI tumors, makes oligometastatic concepts in the sense of a&#xa0;cure appear questionable. Local therapies such as metastasectomy or stereotactic radiotherapy can have a&#xa0;curative effect in well-selected cases—in the case of colorectal cancer, sometimes with a&#xa0;5-year survival of up to 60%. The combination of local treatment with systemic therapies shows high local control rates but involves risks such as treatment breaks and postoperative complications. The role of additive therapies after metastatic ablation using surgical or radiotherapeutic approaches remains unclear and is being further investigated in prospective studies.</p>

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Therapie bei oligometastasierten gastrointestinalen Tumoren

  • 期刊论文

  • 发表日期：

    2025年5月19日

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  • Thorsten Oliver Götze,
  • Maximilian Kloft,
  • Emmanouil Fokas,
  • Thomas Schmidt,
  • Hendrik Dapper

摘要

In contrast to the diffuse metastatic situation, oligometastatic gastrointestinal (GI) tumors are characterized by metastases that affect only a few organs. While local therapies are established for tumors such as melanoma or breast cancer, the evidence for GI tumors varies. However, the combination of systemic, surgical, and radiotherapeutic approaches shows promising results, particularly in colorectal cancer. The definition and classification of oligometastatic stages is essential for treatment decisions. Synchronous, metachronous, de novo, or treatment-induced oligometastases differ in their biological development and clinical dynamics. Tumor burden is a key prognostic factor. Systemic therapies in the oligometastatic situation serve reduction of the tumor burden as well as biological selection in order to enable local treatment of the primary tumor and/or metastases, be it by resection or radiotherapy. Induction chemotherapy is important to put patients in the best possible condition for local treatments. Immune and targeted therapies expand the options for selected patients, especially in the presence of specific molecular markers, and can achieve very good treatment responses. They have the potential to convert tumor diseases from diffuse metastasis to oligometastasis, whereby the presence of diffuse metastases, especially from upper GI tumors, makes oligometastatic concepts in the sense of a cure appear questionable. Local therapies such as metastasectomy or stereotactic radiotherapy can have a curative effect in well-selected cases—in the case of colorectal cancer, sometimes with a 5-year survival of up to 60%. The combination of local treatment with systemic therapies shows high local control rates but involves risks such as treatment breaks and postoperative complications. The role of additive therapies after metastatic ablation using surgical or radiotherapeutic approaches remains unclear and is being further investigated in prospective studies.