Perspectives on the Management of Oligometastatic Disease in Esophago-Gastric Cancer

Abstract

Gastric adenocarcinoma and esophageal cancer are the fifth and seventh most common cancer types worldwide. At the time of initial diagnosis, up to 50% of esophagogastric cancers present with distant metastatic lesions and are candidates for chemotherapy. Curative surgery in this stage is still an experimental approach. Only a small number of these metastatic patients show an oligometastatic disease with no uniform definition of what oligometastatic means in gastric cancer. Nevertheless, the question remains unanswered as to whether these patients are still candidates for curative concepts. Some studies have attempted to answer this question but have not been adequately designed to address the role of a curative-intended multimodal therapy in this setting. The current FLOT-5 is designed to potentially provide a definitive answer to the question of whether curatively intended surgery plays a role or is a disadvantage in this setting.

Keywords: Peritoneal Cancer Index; chemotherapy; gastric cancer; gastroesophageal cancer; immunotherapy; limited metastatic disease; oligometastatic disease; peritoneal carcinomatosis.

Figure 1

Useful questions to further define OMD, based, with modifications, on (Guckenberger et al., 2020) [18].

Figure 2

Information for decision-making used by the FLOT-5 central review expert panel.