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Oligometastatic Colorectal Cancer: A Review of Definitions and Patient Selection for Local Therapies

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Abstract

Purpose

Nearly one-third of patients diagnosed with colorectal cancer (CRC) will ultimately develop metastatic disease. While a small percentage of patients can be considered for curative resection, more patients have limited disease that can be considered for local therapy. Challenges remain in defining oligometastatic CRC as well as developing treatment strategies guided by high level evidence.

Methods

In this review, we present the challenges in defining oligometastatic CRC and summarize the current literature on treatment and outcomes of local therapy in patients with metastatic CRC.

Results

For patients with liver- and/or lung-confined CRC metastases, surgical resection is the standard of care given the potential for long-term progression-free and overall survival. For patients with liver- or lung-confined disease not amenable to surgical resection, non-surgical local therapies, such as thermal ablation, hepatic arterial infusion pump (HAIP), or stereotactic body radiation therapy (SBRT), should be considered. For patients with more advanced disease, such as lymph node or bony metastases, the role of metastasis-directed therapy is controversial. Emerging data suggests that SBRT to ablate all metastases can improve progression-free and overall survival.

Conclusion

Multidisciplinary management is critical for patients with metastatic CRC due to the complexity of their cases and the nuanced patient, tumor, biological, and anatomical factors that must be weighed when considering local therapy. High-quality prospective randomized data in CRC are needed to further clarify the role of local ablative therapy in patients with unresectable oligometastatic CRC with ongoing studies including the RESOLUTE trial (ACTRN12621001198819) and the upcoming NCTN ERASur trial (NCT05673148).

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Acknowledgements

The authors would like to thank Jennifer Huber for editorial assistance.

Funding

EDM is supported by a NIH/NCI Cancer Center Support Grant (P30 CA16058). PBR is supported by a NIH/NCI Cancer Center Support Grant (P30 CA008748) and a NIH/NCI early career development award (K08 CA255574).

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Author notes

  1. Eric D. Miller, Kathryn E. Hitchcock and Paul B. Romesser contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center, 460 W. 10Th Ave., Room A209, Columbus, OH, 43210, USA

    Eric D. Miller

  2. Department of Radiation Oncology, University of Florida Health, Gainesville, FL, USA

    Kathryn E. Hitchcock

  3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Paul B. Romesser

  4. Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Paul B. Romesser

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  1. Eric D. Miller
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All authors participated in drafting and critical review of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Eric D. Miller.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

EDM has served as a consultant for Varian Medical Systems. KEH reports research relationships with Elekta, Merck, and BioMimetix that are unrelated to the topic of this review. PBR received research funding and serves as a consultant for EMD Serono, receives research funding from XRAD Therapeutics, is a consultant for Faeth therapeutics, and is a consultant for Natera.

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Miller, E.D., Hitchcock, K.E. & Romesser, P.B. Oligometastatic Colorectal Cancer: A Review of Definitions and Patient Selection for Local Therapies. J Gastrointest Canc 54, 1116–1127 (2023). https://doi.org/10.1007/s12029-022-00900-5

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