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. 2024 Aug 10:48:100838.
doi: 10.1016/j.ctro.2024.100838. eCollection 2024 Sep.

Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice

Sebastian M Christ  1 , Minsu Breitenstein  2 , Philip Heesen  2 , Brandon Turner  3 , Urs J Muehlematter  4 , Kaspar Pohl  2 , Jonas Willmann  1 , Alexander Maurer  4 , Sukhdeep K Nagpal  5 , Maiwand Ahmadsei  1 , Eugenia Badra Vlaskou  1 , Esmée L Looman  1 , Astrid E Heusel  1 , Michael Mayinger  1 , Panagiotis Balermpas  1 , Andreas Wicki  6 , Nicolaus Andratschke  1 , Tracy Balboni  3 , Mai Anh Huynh  3 , Martin Huellner  4 , Matthias Guckenberger  1
Affiliations

Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice

Sebastian M Christ et al. Clin Transl Radiat Oncol. .

Abstract

Aims: Multidisciplinary tumor boards (MDTs) are an integral part of ensuring high-quality, evidence-based and personalized cancer care. In this study, we aimed to evaluate the adherence to and implementation of MDT recommendations in patients with oligometastatic disease (OMD).

Methods: We screened all oncologic positron emission tomography (PET) scans conducted at a single comprehensive cancer center in 2020. Patients were included if they had evidence of imaging-based OMD from a solid organ malignancy on the index scans, had their OMD case discussed at an MDT, and were treated and followed up at the same center. A switch away from the MDT-recommended treatment modalities was classified as a major deviation; non-MDT-mandated adjustments to a recommended treatment modality were coded as minor deviation. Clinical data was obtained via chart review; statistical calculations were computed using the R software.

Results: After review of PET and/or concurrent brain scans, 787 cases of OMD were identified. Thereof, 347 (44.1 %) cases were discussed at MDT, of which 331 (42.1 %) were therapeutically managed and subsequently followed. The three most commonly recommended therapies were systemic therapy (35.6 %), multimodality treatment including definitive local therapy (17.8 %), and radiotherapy (13.9 %). A major deviation was recorded in 16.3 % of cases (most commonly: none of the MDT-recommended treatment modalities were performed: 19 (35.2 %); not all MDT-planned treatment modalities were performed: 12 (22.2 %); and additional treatment modality was performed: 11 (20.3 %). A minor deviation was found in 1.5 % of cases. On multivariable regression, number of distant metastases (n > 1) was associated with a major deviation (OR: 1.85; 95 % CI, 1.0-3.52). Major deviations were associated with a significantly worse OS (p = 0.0034).

Conclusions: Adherence to and implementation of MDT recommendations in OMD patients was generally high (83.7%). Major deviations might be further reduced by more careful and elaborate discussions of OMD patient characteristics s and patient preferences.

Keywords: Multidisciplinary tumor board; Oligometastasis; Therapeutic management.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AW received research grants through a research collaboration (“POP”) of the University of Zurich with Hoffmann-La Roche Ltd. MAH received research grants from Immune-Sensor, Inc. and ViewRay, Inc., as well as speaking honoraria for presenting at the Harvard Medical School Breast Cancer Symposium. M.H. received grants and speaker honoraria from GE Healthcare, a fund by the Alfred and Annemarie von Sick legacy and a grant from the clinical research priority program (CRPP) Artificial Intelligence in Oncological Imaging Network of the University of Zurich. NA has received grants from ViewRay Inc. and BrainLab and personal fees from AstraZeneca, Debiopharm, ViewRay and BrainLab, and non-financial support from ViewRay, all outside of the submitted work. MG has received grants from AstraZeneca and Varian and personal fees from AstraZeneca, all outside of the submitted work. Moreover, the USZ Department of Radiation Oncology has research and teaching agreements with Siemens/Varian, ViewRay and VisionRT. PB cited research grants to the institution from ViewRay Inc. (Mountain View, CA, USA).

Figures

Fig. 1
Fig. 1
Patient screening, inclusion and exclusion criteria. Abbreviations: CCCZ=Comprehensive Cancer Center Zurich; MDT=Multidisciplinary tumor board; MRI=Magnetic resonance imaging; OMD=Oligometastatic disease; OS=Overall survival; PET=Positron emission tomography.
Fig. 2
Fig. 2
Timeline from OMD diagnosis to MDT discussion, treatment and follow-up for the median OMD patient. Abbreviations: IQR=Interquartile range; MDT=Multidisciplinary tumor board; OMD=Oligometastatic disease; OS=Overall survival.
Fig. 3
Fig. 3
Kaplan-Meier overall survival plot with log-rank p-value, stratified by major deviation.
See this image and copyright information in PMC

References

    1. Mano M.S., Çitaku F.T., Barach P. Implementing multidisciplinary tumor boards in oncology: a narrative review. Future Oncol. 2022;18(3):375–384. doi: 10.2217/fon-2021-0471. Future Medicine Ltd. - DOI - PubMed
    1. Brauer D.G., et al. Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study. HPB. 2017;19(2):133–139. doi: 10.1016/j.hpb.2016.11.002. - DOI - PMC - PubMed
    1. Tamburini N., et al. Multidisciplinary management improves survival at 1 year after surgical treatment for non-small-cell lung cancer: a propensity score-matched study. Eur J Cardiothorac Surg. 2018;53(6):1199–1204. doi: 10.1093/ejcts/ezx464. - DOI - PubMed
    1. Pillay B., et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: a systematic review of the literature. Cancer Treatment Rev. 2016;42:56–72. doi: 10.1016/j.ctrv.2015.11.007. W.B. Saunders Ltd. - DOI - PubMed
    1. Di Pilla A., et al. The impact of tumor boards on breast cancer care: evidence from a systematic literature review and meta-analysis. Int J Environ Res Public Health. 2022;19(22) doi: 10.3390/ijerph192214990. MDPI. - DOI - PMC - PubMed

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