An international group of experts, led by the Medical University of Vienna, has developed uniform criteria for the first time to define oligometastasis in metastatic pancreatic cancer. The consensus statement of the "OligoPanc" project, published in the journal The Lancet Oncology, creates the basis for more targeted therapy strategies in patients with limited metastasis.
Previously, metastatic pancreatic cancer was considered a systemic disease, in which local therapies such as surgery were generally no longer an option. However, recent data suggest that a small subgroup with oligometastatic spread – meaning few metastases – may benefit from a combination of systemic and local treatment. A standardized definition was previously lacking.
Fifty-five experts from 20 countries and five disciplines participated in the multi-stage Delphi consensus process. The project was coordinated by Carl-Stephan Leonhardt and Oliver Strobel (University Department of General Surgery) and Gerald W. Prager (University Department of Internal Medicine I) of MedUni Vienna.
Consensus was reached on the following criteria: Oligometastasis is present with a maximum of three metastases in a single organ – either the liver or the lung. A distinction is made between synchronous oligometastasis (metastases already present at the initial diagnosis) and the metachronous form (metastases occurring later in the course of the disease). In metachronous oligometastasis, a longer time interval between the primary diagnosis and the appearance of metastases is considered prognostically favorable.
To confirm the diagnosis, the group recommends contrast-enhanced computed tomography of the thorax and abdomen, as well as an MRI of the liver. The determination of oligometastasis should fundamentally be made in a multidisciplinary tumor board.
Therapy recommendations are based on case studies: In oligometastatic pancreatic cancer, the majority advocate for a combination of systemic therapy (usually chemotherapy) and local treatment (surgery or radiation therapy). In the synchronous form, simultaneous resection of the primary tumor and metastases is more often favored, while in the metachronous form, local treatment of the metastases (surgical or radiotherapeutic) is preferred.
"Pancreatic cancer remains one of the most aggressive tumor diseases with high lethality," emphasizes Oliver Strobel. The new definition makes it possible for the first time to clearly identify patients with a potentially curative or life-prolonging approach. Furthermore, it creates the prerequisite for comparable study results and the further development of evidence-based therapy strategies.
The OligoPanc project was published in The Lancet Oncology (DOI: 10.1016/S1470-2045(25)00714-4).
