OLIGO-AIRO: a national survey on the role of radiation oncologist in the management of OLIGO-metastatic patients on the behalf of AIRO

'Perspectives of pulmonologists and thoracic surgeons on Oligometastatic disease: curability, treatment approaches, and disease trajectory'

BACKGROUND

Oligometastatic disease (OMD) is defined by a limited number of metastases, affecting treatment strategies and prognosis. This study evaluates the perspectives of pulmonologists and thoracic surgeons on the curability, treatment approaches, and disease trajectory of synchronous OMD, oligorecurrence, and oligoprogression.

METHODS

A survey was conducted among pulmonologists, thoracic surgeons, and trainees at Yedikule Chest Disease and Thoracic Surgery Research and Training Hospital. Participants provided views on OMD's curability, treatment preferences, and confidence in discussing prognosis using Likert scales. Data were analyzed using descriptive statistics and comparative methods.

RESULTS

Of 160 contacted participants, 60 (37.5%) completed the survey. Most respondents (86.6%) regarded synchronous OMD as curable, with 65% for oligorecurrence and only 23.4% for oligoprogression. Confidence in understanding synchronous OMD's trajectory significantly differed, with attending physicians at 67.9% versus trainees at 43.8% (p < 0.05). Thoracic surgeons had higher confidence in oligorecurrence (88.3%) than pulmonologists (46%, p < 0.05). A preference for combined systemic and local therapies was noted: 73.3% for synchronous OMD, 75% for oligorecurrence, and 78.4% for oligoprogression.

CONCLUSION

The study reveals diverse perspectives on OMD, highlighting the need for multidisciplinary collaboration and ongoing education to improve understanding and management of the disease.

International consensus on radiotherapy in metastatic non-small cell lung cancer

BACKGROUND

Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.

METHODS

International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.

RESULTS

Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.

CONCLUSIONS

In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: The Current and Future Role of Radiation Therapy in the Era of Immunotherapy

Radiation therapy (RT) is an effective therapeutic option for small localized cutaneous squamous cell carcinoma (cSCC) among patients who are not eligible for or refuse surgery. RT also has a defined role as an adjuvant treatment in cases of adverse features that predispose to tumor recurrence after local excision. Since the development of cSCC is often a late consequence of chronic sun exposure, its occurrence is more common among elderly patients whose comorbidities may contraindicate surgical procedures. These could be impeded not only by frail medical conditions but also by technical issues. Indeed, an aggressive locoregional behavior of cSCC may culminate in unresectability due to widespread invasion of neighboring tissues. Moreover, cSCC could develop distant metastases. Both locally advanced and metastatic cSCCs carry a poor prognosis. In these scenarios, recent discoveries of tumor molecular targets are promoting the use of promising systemic therapies, especially immunotherapy, over RT. However, the results from using immunotherapy and, even more so, of chemotherapy are still not optimal. By contrast, advances in radiation delivery equipment can safely treat even large and complex-shaped cSCC targets in challenging body sites. In addition, RT could also have a role in metastatic cSCC settings by enhancing the effectiveness of concomitant immunotherapy. The aim of this review is to summarize and comment on the body of literature about the use of radiotherapy for operable and inoperable locally advanced cSCCs and for metastatic ones in an attempt to define its current and future role.