Treatment-induced cardiac toxicity represents an important issue in non-small cell lung cancer (NSCLC) patients, and no biomarkers are currently available in clinical practice. A novel and easy-to-calculate marker is the quantitative analysis of calcium plaque in the coronary, calculated on CT. It is called the Agatston score (or CAD score). At the same time, other potential predictors include cardiac ultrasonography and anamnesis of the patients. Our work aimed to correlate cardiac biomarkers with overall survival (OS) in NSCLC patients. We retrospectively analyzed patients with NSCLC discussed in the Multidisciplinary Tumor Board of our Institute for the present analysis between January 2018 and July 2022. Inclusion criteria were the availability of basal CT imaging of the thorax, cardiac ultrasonography with the calculation of ejection fraction (EF), and complete anamnesis, including assessment of co-pathologies and pharmacological drugs. The clinical data of the patients were retrospectively collected, and the CAD scores was calculated on a CT scan. All of these parameters were correlated with overall survival (OS) with univariate analysis (Kaplan–Meier analysis) and multivariate analysis (Cox regression analysis). Following the above-mentioned inclusion criteria, 173 patients were included in the present analysis. Of those, 120 patients died in the follow-up period (69.6%), and the median overall survival (OS) was 28 months (mean 47.2 months, 95% CI, 36–57 months). In univariate analysis, several parameters that significantly correlated with lower OS were the stage (p < 0.001), the CAD grading (p < 0.001), history of ischemic heart disease (p: 0.034), use of beta blocker drugs (p: 0.036), and cardiac ejection fraction (p: 0.005). In multivariate analysis, the only parameters that remained significant were as follows: CAD score (p: 0.014, OR 1.56, 95% CI: 1.04–1.83), stage (p: 0.016, OR: 1.26, 95% CI: 1.05–1.53), and cardiac ejection fraction (p: 0.011, OR 0.46, 95% CI: 0.25–0.84). Both CAD score and ejection fraction are correlated with survival in NSCLC patients at all stages of the disease. Independently from the treatment choice, a cardiological evaluation is mandatory for patients with NSCLC.

https://www.mdpi.com/2075-4418/13/3/400/pdf?version=1674372346

Role of Cardiac Biomarkers in Non-Small Cell Lung Cancer Patients

The paradigm of oligometastatic disease (OMD), characterized by a limited number of metastases potentially amenable to local therapies, presents unique opportunities and challenges in clinical trial design and implementation. Although local ablative therapies, such as stereotactic body radiation therapy, have shown promise in improving outcomes for patients with OMD, there is a lack of large-scale randomized phase III trials supporting their widespread use. This paper outlines the key challenges in trial design and implementation in the oligometastatic setting, including appropriate patient selection, the definition of the oligometastatic state, trial design considerations, endpoint selection, and logistical considerations related to enrollment and follow-up. We suggest potential strategies to address these challenges, emphasizing the importance of a comprehensive, patient-centric approach, and the integration of multidisciplinary teams in trial design and implementation. The aim is to encourage the design of well-structured clinical trials, ultimately refining best practices and enhancing patient outcomes in the management of OMD. 

Advances and Challenges in Trials of Local Therapy for Patients With Oligometastatic or Oligoprogressive Disease.

Abstract Background: In this study, we aimed to precisely define oligometastatic recurrence (OLR) in patients with esophageal carcinoma (EC) treated with radical resection and investigate the role of local therapy plus chemotherapy in these patients. Methods: Eighty-three patients with EC who underwent radical esophagectomy and two- or three-field lymphadenectomy, had newly diagnosed recurrence between January 2010 and May 2019 in our hospital, and met the inclusion criteria of the study were recruited. Overall survival (OS) curves after recurrence were analyzed using the Kaplan–Meier method, and a log-rank test was used to assess the OS differences between groups. Cox proportional hazards regression analysis was performed to identify independent factors. Results: The median follow-up time was 15 months (range: 1–147 months). Patients with EC with≤ 5 safe and curative metastases located in a single organ had favorable overall survival compared to those with metastases located in 2–3 organs with or without regional recurrence and/or regional lymph node metastases. In our study, OLR was defined as the presence of a maximum of five safe and curative metastases in a single organ. Patients with EC in the OLR group treated with chemotherapy combined with local treatment (surgical resection, stereotactic body radiotherapy, conventional radiotherapy, and radiofrequency ablation) had a better three-year OS after recurrence than those who received chemotherapy (CT) alone (25.7% vs. 8.3%). The multivariate Cox regression model identified treatment method, differentiation degree, and pathological lymph node stage as independent factors affecting OS after recurrence. Conclusion: OLR was defined as ≤ 5 safe and curative metastases in a single organ. Patients with EC with OLR after curative resection treated with chemotherapy combined with local treatment (CCLT) had favorable OS compared to those treated with CT alone. CCLT is a promising treatment option for patients withEC and OLR. 

/pdf/prognostic-viewing-for-patients-with-esophageal-carcinoma-2njs7mjv.pdf

Prognostic viewing for patients with esophageal carcinoma with oligometastatic recurrence after curative resection

Clinical Applications of MR-Linac in Oligometastatic Disease

Challenges in the Understanding of Oligometastatic Disease in Clinical Practice

Abstract Since the first definition by Hellman and Weichselbaum in 1995, the concept of OligoMetastatic Disease (OMD) is a growing oncology field. It was hypothesized that OMD is a clinical temporal window between localized primary tumor and widespread metastases deserving of potentially curative treatment. In real-world clinical practice, OMD is a “spectrum of disease” that includes a highly heterogeneous population of patients with different prognosis. Metastasis directed therapy with local ablative treatment have proved to be a valid alternative to surgical approach. Stereotactic body radiation therapy demonstrated high local control rate and increased survival outcomes in this setting with a low rate of toxicity. However, there is a lack of consensus regarding many clinical, therapeutic, and prognostic aspects of this disease entity. In this review, we try to summarize the major critical features that could drive radiation oncologists toward a better selection of patients, treatments, and study endpoints. With the help of a set of practical questions, we aim to integrate the literature discussion. 

/pdf/a-critical-review-on-oligometastatic-disease-a-radiation-gghedf6m.pdf

A critical review on oligometastatic disease: a radiation oncologist’s perspective

Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study

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A critical review on oligometastatic disease: a radiation oncologist’s perspective

Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study