paradigm shift in the conceptualization of cancer metastasis

[D.ap]

We first heard this Oligo term when we found our brain tumors in December.

Wanted to share this well presented article-

"Oligometastases and Oligo-recurrence: The New Era of Cancer Therapy"Yuzuru Niibe* and
Kazushige Hayakawa


Abstract

Recurrence or metastasis of cancer has been considered to occur in the last stage of the patient's life. However, the new notions of oligometastases and oligo-recurrence have been proposed and the paradigm shift in the conceptualization of cancer metastasis or cancer recurrence. Oligometastases is the state in which the patient shows distant relapse in only a limited number of regions. Local therapy such as surgery, radiotherapy and radiofrequency ablation for the relapsed sites could thus improve patient's survival. On the other hand, oligo-recurrence is a notion similar to oligometastases. However, the conditions of oligo-recurrence has a primary site of the cancer controlled, meaning that all gross recurrent or metastatic sites could be treated using local therapy.

I find the future of local control plus systemic treatments very intriguing in metastic cancers.

SYSTEMIC THERAPY AND LOCAL THERAPY

Improvement of systemic chemotherapy including molecular-targeted therapy has allowed micrometastases to be almost completely absent clinically. Theoretically, if several gross metastatic or recurrent sites could be eradiated by local therapy, these patients could be cured with concomitant systemic chemotherapy. Punglia et al. (5) reported that if systemic therapy improved, the role of local therapy would improve and proposed a figure for this correlation. Here, a new figure of the correlation between local therapy and systemic therapy is proposed (Fig. 3), showing that the role of local therapy is initially increasingly important as systemic therapy improves, depending on the sigmoid curve. The current status of cancer therapy lies in the range between 0 and A. However, in the future, extreme improvements in systemic therapy will decrease the importance of local therapy, because cancers will be diminished by systemic therapy alone such as intravenous anti-cancer drug infusion or oral anti-cancer drugs. All cancerous lesions including gross tumors and microinvasive tumors could be eradicated with systemic therapy alone. This desirable state is shown as B in Fig. 3. In the present status (range: 0–A in Fig. 3), systemic therapy is not yet powerful enough that local therapy is not required for eradication, particularly for gross tumor.




http://jjco.oxfordjournals.org/content/40/2/107.full#F3

[D.ap]

More on oligo approaches


The mechanisms of oligometastases and oligo-recurrence were reviewed, and novel insights are presented. Sync-oligometastases and oligo-recurrence can now be cured by less invasive local treatment methods combined with systemic therapy.

http://www.hindawi.com/journals/pm/2012/261096/

[Bonni Hess]

Dear Debbie,
Thank you for sharing this very interesting article and valuable information. The insights presented in this article that "systemic therapy is not yet powerful enough that local therapy is not required for eradication, particularly for gross tumor. " is of significant importance for those ASPS patients who have chosen either as a result of their oncologist's recommendation or their own reluctance/refusal to have surgical removal of a tumor, to undergo some kind of systemic treatment without first having their large primary tumors resected or otherwise treated to try to shrink and destroy the tumor. Through my 13 and a half years of ASPS experience and extensive research, networking,and observations I have found that resection/destruction of the primary tumor, if surgically possible, seems to be essential for a successful systemic treatment response and outcome because, as noted in this article, currently available systemic treatments are not powerful enough to fight a large tumor burden. I have repeatedly urged several ASPS Community patients to have their large primary tumors resected in order to reduce their body's tumor burden and strengthen the immune system to better fight this very challenging disease, but unfortunately they chose to not undergo surgical removal of the tumor and tragically ultimately lost their courageous battles with the tumor still intact.
With deepest gratitude for your faithful sharing, and continued Hope,
Bonni