An international group of experts led by MedUni Vienna announced on Mar. 10 a new consensus definition for oligometastatic pancreatic cancer, published in The Lancet Oncology. This agreement aims to clarify which patients with metastatic pancreatic cancer may benefit from local treatments such as surgery or radiotherapy in addition to systemic therapy.
The new definition is significant because, until now, there was no uniform standard for identifying patients with a limited number of metastases who might be eligible for more aggressive treatment approaches. Experts say this clarity could improve patient selection and the development of targeted treatment strategies.
Fifty-five specialists from 20 countries and five medical disciplines participated in the structured consensus process, coordinated by Carl-Stephan Leonhardt and Oliver Strobel from MedUni Vienna's Department of General Surgery, along with Gerald W. Prager from the Department of Medicine I. Through a multi-stage anonymous voting process known as the Delphi method and using case studies, the group agreed that oligometastatic pancreatic cancer should be defined as having a maximum of three metastases in a single organ—specifically the liver or lungs. They also distinguished between synchronous oligometastasis (present at initial diagnosis) and metachronous oligometastasis (developing later), noting that a longer interval before metastasis is linked to better prognosis.
For diagnosis, the expert group reached consensus on using contrast-enhanced computed tomography scans of the chest and abdomen, as well as magnetic resonance imaging of the liver. Diagnosis should always involve a multidisciplinary tumor board including surgery, oncology, radiology, and radiotherapy specialists.
Treatment recommendations based on case studies suggest that most experts favor local treatment—such as surgery or radiotherapy—in addition to chemotherapy for these patients. For synchronous cases, surgical removal of both primary tumors and metastases was often recommended; for metachronous cases, surgery or radiation targeting only the metastases was preferred.
"Pancreatic cancer is one of the most aggressive types of cancer and has a high mortality rate," said Oliver Strobel. "With the consensus definition that has now been developed, we can clearly define for the first time which patients can be diagnosed to have an oligometastatic situation. This is an essential prerequisite for specifically identifying those patients who could potentially benefit from local treatment in addition to systemic therapy." He added that this uniform definition will also help compare study results and advance specific treatment strategies.
