Highlights on the Management of Oligometastatic Disease

Purpose: The understanding of oligometastatic disease (OMD) is rapidly evolving and with this comes the ability to utilize a number of modalities that excel in the localized control of disease. It has been identified that there are no clear guidelines based on high-level evidence to standardized approaches toward the management of OMD. These highlights have been developed to provide a road map for all health-care professionals who are involved in the management of OMD to support standardized patient care. Methods: The Saudi Lung Cancer Guidelines Committee is a part of the Saudi Lung Cancer Association which, in turn, is part of the Saudi Thoracic Society. Considering that lung cancer constitutes a major proportion of OMD prevalence, the committee took the initiative to develop national highlights to support the management of OMD within Saudi Arabia. The committee members are national clinical leaders who collaborated with international expertise to establish these highlights to serve as a general clinical pathway in the management of OMD. Results: Standardization of the indications to diagnose oligometastases and patient selection criteria including ineligibility criteria for treatment are the basis of the highlights. Treatment approaches including surgical and the variety of radiotherapeutical options are discussed in relation to specific oligometastatic sites. Acceptable measurements for response to treatment and the future for the treatment of OMD conclude the development of the highlights. Conclusion: These are the first national highlights addressing this important disease in oncology. The implementation of these highlights as guidelines requires a robust multidisciplinary team and access to specific technology and expertise. These highlights are based on the most recent findings within the literature but will require repeated review and updating due to this rapidly evolving field in disease management.

INNV-02. ARE WE AGGRESSIVE WITH OUR GLIOBLASTOMA PATIENTS: A PROPOSED TOOL TO EVALUATE CENTERS ATTITUDES IN TREATMENT OF GLIOBLASTOMA

INTRODUCTION

Glioblastoma is the most common malignant primary brain tumor in adults. Optimal treatment for glioblastoma requires a multidisciplinary approach and knowledge of complications from both the disease and its treatment. Despite modern advances in the standards of care, the outcome in patients with Glioblastoma remains poor. Thus, it is crucial to optimize treatment strategies to improve over-all survival in patients with Glioblastoma, with the therapeutic challenge of “how aggressive a physician should be?” OBJECTIVES: We herein propose a novel method to compare aggressiveness in the standard of care between multiple centers, using a novel tool, and provide a more precise cut-off definition of aggressiveness.

METHOD

Multiple centers were included. A novel case-based questionnaire was generated which included only certain parameters, and then sent and answered jointly by tumor board members from each center. We then stratified centers into more aggressive vs. less aggressive based on our proposed Aggressiveness (AS) score.

RESULTS

In our novel cases, center A scored an AS score of 44 (Mean ± SD; 3.67 ± 1.07), while center B scored 49 (Mean ± SD; 4.08 ± 0.90) In real cases, center A scored 40 (Mean ± SD; 3.25 ± 1.42), while center B scored 44 (Mean ± SD; 3.75 ± 1.29). Our results showed consistency between centers evaluated using our tool. Age and presence of comorbidities were the most influential parameters.

CONCLUSION

In the current study, we present a novel and a reliable tool that can be easily used and replicated to compare aggressiveness in the treatment of Glioblastoma between multiple centers. The methodology we used has never been previously proposed and can serve as a novel concept to compare aggressiveness in treatment of all incurable diseases that require a multidisciplinary approach.