Oligometastatic disease

Introduction and aim

Historically patients with metastatic cancer are considered incurable and treated with palliative therapies. However, some of these patients have long disease-free survival when treated with definitive treatment to all metastatic sites. The implementation of effective systemic therapy has led to a more dynamic view on metastatic disease and the introduction of a prognostic classification system for oligometastatic disease (OMD) including induced oligometastatic disease categories. Clinical randomized trials are emerging for specific patient subgroups and the demand for local ablative therapies including stereotactic ablative radiotherapy (SABR) are increasing.  As the focus on OMD is increasing across the different multidisciplinary cancer groups, a broad collaboration is needed.

The overall aim of IP15 is to provide a develop a national strategy for SABR of oligometastatic disease to ensure a safe SBRT option for all relevant patients to for all metastatic sites in collaboration across centres.

Background

The group was initiated in 2018. There was no supportive framework from a multidisciplinary cancer group, the work had to rely on new initiatives. To explore the Danish clinicians’ awareness of local metastases directed therapy with SABR and their willingness to refer patients for SABR, we conducted a pattern of care survey (van Overeem Felter et al. Acta Oncol 2022). To initiate study collaborations, we arranged workshops on brain and bone metastases.

The collaboration resulted in four phase II trials focusing on oligometastases in the bones, abdominal soft tissue, central/ultra central lung, and brain (re-irradiation).

An important milestone for the group was to initiate a large national multicenter study for patients with oligometastatic disease. In April 2024 the first patient was included in the OLIGO-DK trial.

Projects

Abdominal soft tissue metastases
MR- guided stereotactic ablative radiotherapy of infra-diaphragmatic soft tissue metastases, ClinicalTrials.gov identifier: NCT04407897. Primary investigator: Mette van Overeem Felter. Accrual finished, February 2022.

Bone metastases
BONY-M. Phase 2 study of Stereotactic Ablative Radiotherapy (SABR) of Bony Metastases in Patients with Oligometastatic Disease, ClinicalTrials.gov identifier: NCT05101824. Principal investigator: Gitte Fredberg Persson. Accrual finished January 2022.

Brain metastases
RETREAT – a Phase 2 Study of Re-irradiation for Relapsed Brain Metastases, ClinicalTrials.gov identifier: NCT05126875. Principal investigator: Søren Møller. Open for inclusion.

Lung metastases
Multicenter Phase II Study of Stereotactic Radiotherapy for Centrally Located Lung Tumors (STRICT-LUNG STUDY) and Ultra-centrally Located Lung Tumors (STAR-LUNG STUDY), ClinicalTrials.gov identifier NCT05354596. Co-principal investigators: Mette Pøhl & Lone Hoffmann. Initiated by the Danish Oncology Lung Cancer Group. Open for inclusion, both patient with primary and oligometastatic tumours are eligible.

OLIGO-DK
A National Multidisciplinary Longitudinal Study of Metastases-Directed Local Ablative Therapy for Patients with Oligometastatic Disease - a Combined Interventional and Observational Trial, ClinicalTrials.gov identifier NCT063567799. Primary Investigator: Michael Teindl Laursen.

All patient with any non-haematological cancer in any OMD category are eligible for inclusion if all OMD lesions can be treated with any local ablative therapy modality. Primary endpoint is “time to failure of local ablative therapy strategy”. Open for inclusion.

IP leaders
Azza Khalil, Aarhus University Hospital
Gitte Persson, Copenhagen University Hospital Herlev and Gentofte

Junior IP-leader/secretary
Michael Teindl Laursen, michael.ruben.teindl.laursen@regionh.dk
Copenhagen University Hospital Herlev and Gentofte

Other key people
Aarhus University Hospital
Mette Marie Fode
Esben Schjødt Worm
Lone Hoffmann
Marianne Marquard Knap
Karen Lise Spindler (translational research)

Aalborg University Hospital
Jimmi Søndergaard
Laurids Østergaard Poulsen
Helle Maria Brøgger Sand
Lars Merring-Mikkelsen

Copenhagen University Hospital Herlev and Gentofte
Claus Behrens
Eva Serup-Hansen
Mette van Overeem Felter
Henriette Lindberg
Bodil Engelmann
Jesper Palshof
Susanne Bekke
Wiviann Ottosson
Fatma Gaard-Petersen

Copenhagen University Hospital Rigshospitalet
Maja Vestmøe Maraldo
Mette Pøhl
Morten Suppli
Ivan Vogelius
Kristian Boye
Cécile Peucelle

Danish Centre for Particle Therapy
Britta Weber
Hanna Rahbek Mortensen

Gødstrup Hospital
Trine Øllegaard

Odense University Hospital
Christina Junker Nyborg
Tine Schytte
Lotte Holm Land
Tine Bjørn
Uffe Bernchou
Faisal Mahmood
Franz Rom Poulsen

Vejle Sygehus
Charlotte Kristiansen

Sjællands Universitetshospital
Julie Gehl