Oncologists have differing opinions on whether oligometastatic cancer is curable, according to survey results published in Advances in Radiation Oncology.
The survey also showed varying opinions on how to treat different types of oligometastatic disease.
Forty-four oncologists participated in the survey, and 37 completed it. Of those who completed the survey, 51.4% were radiation oncologists, and 46.0% were medical oncologists. The respondents had a median 13 years of training.
The primary cancer sites the oncologists treated included breast (32.4%), genitourinary (29.7%), gastrointestinal (24.3%), thoracic (21.6%), and central nervous system (18.9%), among others.
Overall, 61.4% of respondents said synchronous oligometastatic disease is curable, 46.2% said oligorecurrent disease is curable, and 13.5% said oligoprogressive disease is curable. These views were similar between radiation oncologists and medical oncologists.
A similar percentage of respondents said they use the words “cure” or “curative” when discussing synchronous oligometastatic disease (31.8%) and oligorecurrent disease (33.3%) with patients. For oligoprogressive disease, 10.8% of respondents use this language with patients.
Views on Treatment
The survey included 3 hypothetical patient cases and asked respondents to make treatment recommendations. For the case with synchronous oligometastatic disease, 68.3% of respondents chose a treatment regimen that combined systemic and local therapy, 24.4% selected systemic treatment only, and 4.9% selected local therapy alone to all sites of disease.
For the case of oligorecurrent disease, 67.6% of respondents selected a combination of systemic and local therapy to all sites of metastatic disease, 27.0% chose systemic therapy only, and 5.4% selected local therapy only to all sites of metastatic disease.
For the case of oligoprogression, 61.1% of respondents selected a combination of systemic and local therapy, with 47.2% choosing local therapy for all sites of growing metastatic disease and 13.9% choosing to treat all sites of metastatic disease. An additional 25.0% of respondents chose systemic treatment only, and 13.9% selected local therapy only (8.3% to all sites of metastatic disease and 5.5% to sites of growing metastatic disease only).
Treatment recommendations differed significantly between medical and radiation oncologists for the synchronous oligometastatic case and the oligoprogression case but not for the oligorecurrence case (P =.62).
Medical oncologists were less likely than radiation oncologists to say they would treat the synchronous oligometastatic patient with systemic and local therapy to all sites of disease (37.5% and 89.5%, respectively; P <.01).
Medical oncologists were also less likely than radiation oncologists to say they would treat the oligoprogression case with systemic treatment and local therapy to sites of growing metastatic disease (37.5% and 57.9%, respectively; P =.02).
“The divergence in views about curability, and variability in treatment recommendations, reflects the insufficient data on outcomes of patients with OMD [oligometastatic disease] and suggests need for further research on this topic, as well as further exploration of oncologist understanding of OMD,” the researchers concluded.
Cho HL, Balboni T, Christ SM, Turner B, Spektor A, Perni S. Is oligometastatic cancer curable? A survey of oncologist perspectives, decision-making, and communication. Adv Rad Oncol. Published online March 17, 2023. doi:10.1016/j.adro.2023.101221