V současné době neexistuje mezinárodní konsenzus, který by zahrnoval chirurgický výkon v rámci standardu léčby metastatického karcinomu pankreatu. Přestože dosud existuje málo důkazů pro obecné zavedení chirurgické resekce v léčbě metastatického karcinomu pankreatu, tak ve vzácných případech pouze oligometastatického rozsevu přibývá sdělení, že chirurgická intervence může vést k příznivým výsledkům. Individualizace péče a terapie na míru (tailored therapy) se netýká pouze cílené léčby, ale celé komplexní onkologické péče, vč. indikace k chirurgickému výkonu. Tento přehled shrnuje současný stav kombinované onkochirurgické léčby v multidisciplinární léčbě oligometastatického karcinomu pankreatu spolu s vlastními zkušenostmi a diskutuje budoucí perspektivy, zejména stran prognostických a prediktivních faktorů, které by tuto skupinu dokázaly lépe predikovat.

Currently, no international consensus includes surgery as part of the standard of metastatic pancreatic ductal adenocarcinoma care. There is weak evidence to support the general introduction of surgical resection in the metastatic pancreatic ductal adenocarcinoma treatment. However, in the rare cases of oligometastatic spread there is increasing evidence that surgical intervention can lead to favourable outcomes. Individualisation of the care and tailored therapy refers not only to targeted treatment but also to the whole complex cancer care, including the indication for surgery. This review summarizes the current status of combined oncosurgical therapy in the multidisciplinary management of oligometastatic pancreatic cancer, together with our own experience, and discusses future perspectives, particularly regarding prognostic and predictive factors that could better predict this group.

• MeSH
• Survival Analysis MeSH
• Adult MeSH
• Precision Medicine * MeSH
• Middle Aged MeSH
• Humans MeSH
• Metastasectomy MeSH
• Neoplasm Metastasis therapy   MeSH
• Pancreatic Neoplasms * therapy   MeSH
• Neoadjuvant Therapy MeSH
• Prognosis MeSH
• Antineoplastic Combined Chemotherapy Protocols MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Úvod: Karcinom pankreatu je jedním z nejagresivnějších nádorových onemocnění, které je ve více než v polovině případů diagnostikováno v lokálně pokročilém nebo metastatickém stadiu. Prognóza těchto nemocných je velmi špatná. Standardním postupem je paliativní chemoterapie prodlužující život nemocných s mediánem celkového přežití méně než 1 rok. Existuje však vybraná skupina oligometastatických pacientů, která může profitovat z resekčního výkonu. Vzhledem k tomu, že se jedná o poměrně malou část pacientů, chybí nám v současnosti rozsáhlé klinické studie přesně definující strategii, efektivitu a bezpečnost tohoto postupu. Kazuistika: Sedmdesátisedmiletý muž s duktálním adenokarcinomem kaudy pankreatu a solitární metastázou v játrech. Po čtyřech cyklech chemoterapie byla provedena distální pankreatektomie s jaterní metastazektomií. Kompletní patologická odpověď byla nalezena v primárním nádoru a reziduálním adenokarcinomu v jaterní metastáze. Následně indikovaná adjuvantní chemoterapie gemcitabinem musela být ukončena při druhém cyklu pro hematologickou toxicitu a intoleranci a pacient v kompletní remisi nemoci je nadále dispenzarizován. Výsledky: Pacient žije bez recidivy více než 2 roky od stanovení diagnózy.

Introduction: Pancreatic cancer is one of the most aggressive tumors diagnosed in locally advanced or metastatic stage in more than half of the cases. The standard of care is a systemic chemotherapy but the prognosis of metastatic patients remains extremely poor with a median overall survival less than one year. However, there is increasing evidence of surgery treatment benefit in a carefully selected oligometastatic cases. Because oligometastatic pancreatic cancer is rare, there is a lack of robust clinical trials defining strategy, efficacy and safety of this procedure. Patient concerns: A 77-year-old man presented with a mass in the tail of the pancreas and solitary liver metastasis. After four cycles of chemotherapy, distal pancreatectomy with liver metastasectomy was performed, and the tissues were histologically examined. The complete pathological response was found in the primary tumor and residual adenocarcinoma in liver metastasis. Outcomes: The patient is alive without recurrency more than two years from the diagnosis.

• MeSH
• Adenocarcinoma surgery   diagnostic imaging   therapy   MeSH
• Humans MeSH
• Metastasectomy MeSH
• Neoplasm Metastasis therapy   MeSH
• Liver Neoplasms surgery   secondary   MeSH
• Pancreatic Neoplasms * surgery   diagnostic imaging   therapy   MeSH
• Neoadjuvant Therapy * MeSH
• Pancreatectomy MeSH
• Antineoplastic Combined Chemotherapy Protocols MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Adult MeSH
• Analgesia, Epidural methods   adverse effects   MeSH
• Horner Syndrome * etiology   pathology   MeSH
• Humans MeSH
• Metastasectomy MeSH
• Postoperative Complications MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Administration, Cutaneous MeSH
• Buprenorphine administration & dosage   MeSH
• Adult MeSH
• Humans MeSH
• Metastasectomy adverse effects   MeSH
• Cancer Pain * diagnosis   drug therapy   MeSH
• Lung Neoplasms surgery   MeSH
• Treatment Failure MeSH
• Pneumonectomy adverse effects   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Despite growing interest in metastasis-directed therapy (MDT) for prostate cancer (PCa), little is known regarding the feasibility and effectiveness of surgical metastasectomy for isolated lesions. We performed a narrative review of the available evidence supporting metastasectomy for M1b-c lesions in men diagnosed with oligometastatic or oligorecurrent PCa. The case series and case reports we identified indicate that surgical MDT is a safe and feasible treatment option for well-selected patients with a small number of PCa metastases diagnosed via molecular imaging. It is difficult to draw evidence-based conclusions regarding the survival benefit of metastasectomy; however, metastasectomy might lead to a prostate-specific antigen response and could potentially delay systemic therapy in patients with oligometastatic PCa. Prospective studies incorporating novel imaging are needed to better establish the role of metastasectomy for patients with metastatic PCa. PATIENT SUMMARY: We reviewed the evidence on surgical removal of prostate cancer lesions that have spread to the organs (eg, liver and lung) or bone, which are called metastases. Limited results show that this approach is feasible and has favorable outcomes in selected patients.

• MeSH
• Humans MeSH
• Metastasectomy * methods   MeSH
• Prostatic Neoplasms * pathology   MeSH
• Prospective Studies MeSH
• Prostate-Specific Antigen MeSH
• Radiosurgery * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

• MeSH
• Leukemia, Lymphocytic, Chronic, B-Cell diagnosis   MeSH
• Diagnostic Imaging methods   MeSH
• Humans MeSH
• Metastasectomy methods   MeSH
• Neoplasm Metastasis drug therapy   MeSH
• Pancreatic Neoplasms * surgery   diagnosis   drug therapy   MeSH
• Neuroendocrine Tumors * diagnosis   drug therapy   MeSH
• Pancreatectomy methods   MeSH
• Aged MeSH
• Somatostatin analogs & derivatives   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

Kazuistika popisuje případ pacienta s karcinomem pankreatu, který po operaci a adjuvantní terapii časně progredoval do metastatického stadia. Paliativní systémová léčba v rámci druhé linie léčby metastatického onemocnění vedla k dlouhodobé kontrole onemocnění s následnou metastasektomií reziduálních plicních ložisek. Při časném relapsu po resekci metastáz onemocnění byl pacient léčen s ohledem na výsledky NGS vyšetření platinovým derivátem. Personalizovaná terapie vedla k časné odpovědi a opětovné kontrole onemocnění. V budoucnu je u pacienta v plánu maintenance terapie PARP inhibitory.

We present a case report of a patient with pancreatic cancer who developed metastatic disease early after surgery and adjuvant therapy. Palliative systemic treatment resulted in long-term control of the disease, followed by pulmonary metastasectomy of residual lesions. Early relapse of the disease after metastasectomy was treated with platinum derivatives, based on the results of NGS testing. Personalized treatment has led to a rapid response and stabilization of the disease. Maintenance therapy with PARP inhibitors will follow in the future.

• MeSH
• CA-19-9 Antigen analysis   MeSH
• Radiotherapy Dosage MeSH
• Chemoradiotherapy MeSH
• Precision Medicine * MeSH
• Middle Aged MeSH
• Humans MeSH
• Metastasectomy MeSH
• Neoplasm Metastasis diagnostic imaging   MeSH
• Lung Neoplasms surgery   diagnostic imaging   secondary   therapy   MeSH
• Pancreatic Neoplasms * surgery   diagnosis   drug therapy   pathology   therapy   MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Pancreatectomy MeSH
• Recurrence MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. OBJECTIVE: To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. MATERIAL AND METHODS: European expert centers (n = 49) were requested to discuss 15 real-life cases in their MDT with at least a medical, surgical, and radiation oncologist present. The cases varied in terms of location and number of metastases, histology, timing of detection (i.e. synchronous versus metachronous), primary tumour treatment status, and response to systemic therapy. The primary outcome was the agreement in the definition of oligometastatic disease at diagnosis and after systemic therapy. The secondary outcome was the agreement in treatment strategies. Treatment strategies for oligometastatic disease were categorised into upfront local treatment (i.e. metastasectomy or stereotactic radiotherapy), systemic therapy followed by restaging to consider local treatment or systemic therapy alone. The agreement across MDTs was scored to be either absent/poor (<50%), fair (50%-75%), or consensus (≥75%). RESULTS: A total of 47 MDTs across 16 countries fully discussed the cases (96%). Oligometastatic disease was considered in patients with 1-2 metastases in either the liver, lung, retroperitoneal lymph nodes, adrenal gland, soft tissue or bone (consensus). At follow-up, oligometastatic disease was considered after a median of 18 weeks of systemic therapy when no progression or progression in size only of the oligometastatic lesion(s) was seen (consensus). If at restaging after a median of 18 weeks of systemic therapy the number of lesions progressed, this was not considered as oligometastatic disease (fair agreement). There was no consensus on treatment strategies for oligometastatic disease. CONCLUSION: A broad consensus on definitions of oligometastatic oesophagogastric cancer was found among MDTs of oesophagogastric cancer expert centres in Europe. However, high practice variability in treatment strategies exists.

• MeSH
• Humans MeSH
• Lymph Nodes MeSH
• Metastasectomy * MeSH
• Neoplasm Metastasis MeSH
• Neoplasms * MeSH
• Radiosurgery * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe MeSH

• MeSH
• Carcinoma, Transitional Cell * surgery   therapy   MeSH
• Clinical Decision-Making MeSH
• Middle Aged MeSH
• Humans MeSH
• Metastasectomy * MeSH
• Neoplasm Metastasis therapy   MeSH
• Prognosis MeSH
• Patient Selection MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH
• Comment MeSH
• Overall MeSH

Cytoreduktivní nefrektomie následovaná systémovou terapií byla považována v éře cytokinů za standardní péči o pacienty s metastazujícím renálním karcinomem. Zveřejnění dvou randomizovaných klinických studií (CARMENA a SURTIME) oživilo debatu o užitečnosti cytoreduktivní nefrektomie a optimální postupnosti léčby u pacientů nově diagnostikovaných s metastazujícím karcinomem ledvin. V éře imunoterapie budou pro podporu cytoreduktivní nefrektomie potřebné prospektivní klinické studie.

Cytoreductive nephrectomy followed by systemic therapy had been considered the standard of care for metastatic renal cell carcinoma patients during the cytokines era. The publication of two randomized clinical trials (CARMENA and SURTIME) has reinvigorated debate about the utility of cytoreductive nephrectomy as well as the optimal treatment sequence for patients newly diagnosed with metastatic renal cancer. The prospective clinical trials supporting cytoreductive nephrectomy were needed in immunotherapy era.

• Keywords
• studie CARMENA, studie SURTIME,
• MeSH
• Survival Analysis MeSH
• Immune Checkpoint Inhibitors therapeutic use   MeSH
• Carcinoma, Renal Cell * surgery   drug therapy   therapy   MeSH
• Clinical Trials, Phase III as Topic MeSH
• Combined Modality Therapy methods   statistics & numerical data   MeSH
• Humans MeSH
• Metastasectomy methods   MeSH
• Neoplasm Metastasis therapy   MeSH
• Nephrectomy * MeSH
• Randomized Controlled Trials as Topic MeSH
• Sunitinib therapeutic use   MeSH
• Check Tag
• Humans MeSH