Background

A survey of medical oncologists (MOs), radiation oncologists (ROs), and surgical oncologists (SOs) who are experts in the management of patients with metastatic colorectal cancer (mCRC) was conducted to identify factors used to consider metastasis-directed therapy (MDT).

Materials and Methods

An online survey to assess clinical factors when weighing MDT in patients with mCRC was developed based on systematic review of the literature and integrated with clinical vignettes. Supporting evidence from the systematic review was included to aid in answering questions.

Results

Among 75 experts on mCRC invited, 47 (response rate 62.7%) chose to participate including 16 MOs, 16 ROs, and 15 SOs. Most experts would not consider MDT in patients with 3 lesions in both the liver and lung regardless of distribution or timing of metastatic disease diagnosis (6 vs. 36 months after definitive treatment). Similarly, for patients with retroperitoneal lymph node and lung and liver involvement, most experts would not offer MDT regardless of timing of metastatic disease diagnosis. In general, SOs were willing to consider MDT in patients with more advanced disease, ROs were more willing to offer treatment regardless of metastatic site location, and MOs were the least likely to consider MDT.

Conclusions

Among experts caring for patients with mCRC, significant variation was noted among MOs, ROs, and SOs in the distribution and volume of metastatic disease for which MDT would be considered. This variability highlights differing opinions on management of these patients and underscores the need for well-designed prospective randomized trials to characterize the risks and potential benefits of MDT.

MicroAbstract

The role of metastasis-directed therapy (MDT) in patients with metastatic colorectal cancer (mCRC) with disease involving more than just the liver remains controversial and is marked by a paucity of prospective evidence. A survey of multidisciplinary experts in the management of mCRC identified wide variability based on provider specialty in the distribution and extent of metastatic disease for which MDT would be recommended.

中文翻译：

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转移性结直肠癌患者转移定向治疗的考虑：专家调查和系统评价

背景

对转移性结直肠癌 (mCRC) 患者管理方面的专家肿瘤内科医生 (MO)、放射肿瘤科医生 (RO) 和肿瘤外科医师 (SO) 进行了一项调查，以确定用于考虑转移定向治疗 (MDT) 的因素）。

材料和方法

基于对文献的系统回顾并与临床案例相结合，开发了一项在线调查，用于评估 mCRC 患者进行 MDT 时的临床因素。系统评价中的支持证据也被纳入其中，以帮助回答问题。

结果

在邀请的 75 名 mCRC 专家中，47 名（答复率 62.7%）选择参加，其中包括 16 名 MO、16 名 RO 和 15 名 SO。大多数专家不会考虑对肝脏和肺部同时出现 3 个病变的患者进行 MDT，无论转移性疾病诊断的分布或时间（确定性治疗后 6 个月与 36 个月）如何。同样，对于腹膜后淋巴结以及肺和肝脏受累的患者，无论转移性疾病诊断的时间如何，大多数专家都不会提供MDT。一般来说，SOs 愿意考虑对晚期疾病患者进行 MDT，ROs 更愿意提供治疗，无论转移部位位置如何，而 MOs 最不可能考虑 MDT。

结论

在护理 mCRC 患者的专家中，MO、RO 和 SO 之间在考虑 MDT 的转移性疾病的分布和体积方面存在显着差异。这种差异凸显了对这些患者管理的不同意见，并强调需要精心设计的前瞻性随机试验来描述 MDT 的风险和潜在益处。

微摘要

转移定向治疗 (MDT) 在疾病不仅仅涉及肝脏的转移性结直肠癌 (mCRC) 患者中的作用仍然存在争议，并且缺乏前瞻性证据。对 mCRC 管理方面的多学科专家进行的一项调查发现，根据提供者的专业知识，推荐 MDT 的转移性疾病的分布和范围存在很大差异。