Good intentions.

Top Line: Local treatment of the primary tumor site in the setting of distant disease has known advantages for cancers such as prostate, renal cell, and non-small cell lung cancer.

The Study: Local therapy plays an important role in oligometastatic rectal cancer, especially if the primary and metastases are resectable. But how might patients do with a non-operative approach using short-course radiation and chemotherapy?  Here is a look back at 36 patients with oligometastatic rectal cancer who received definitive short course pelvic radiation and sequential chemo followed by surgery if no complete clinical response between 2018-2020 at Wash U. While there is no comparator arm to elucidate impact on overall disease course, with over half of patients alive at 2 years (57%), control of pelvic symptoms is a top concern. To that end, local control was much the same as seen with localized disease: 6/36 (17%) achieved cCR, and, while only 12/30 of the remaining actually proceeded to surgery, the local failure rate was 4/36 (11%). Rates of common pelvic symptoms were also on par: obstruction (8/36, 22%), rectal bleeding (5/36, 14%), and permanent ostomy (5/36, 14%). Finally, hypothesis-generating is the observation that the half of patients (n=18) who also received definitive treatment of oligomets had a significantly lower risk of death (HR 0.17).

TBL: Non-operative local management for oligometastatic rectal cancer for complete responders may be a reasonable strategy to prevent pelvic symptoms. | Schiff, Pract Radiat Oncol 2022