Future directions in the evaluation and management of newly diagnosed metastatic cancer

Eric J Lehrer; Chachrit Khunsriraksakul; Sara Garrett; Daniel M Trifiletti; Jason P Sheehan; Matthias Guckenberger; Alexander V Louie; Shankar Siva; Piet Ost; Karyn A Goodman; Laura A Dawson; Leila T Tchelebi; Jonathan T Yang; Timothy N Showalter; Henry S Park; Daniel E Spratt; Amar U Kishan; Gaorav P Gupta; Chirag Shah; Stefano Fanti; Jeremie Calais; Ming Wang; Kathryn Schmitz; Dajiang Liu; John A Abraham; Robert T Dess; Irène Buvat; Benjamin Solomon; Nicholas G Zaorsky

doi:10.1016/j.critrevonc.2025.104631

Future directions in the evaluation and management of newly diagnosed metastatic cancer

Crit Rev Oncol Hematol. 2025 Jan 24:104631. doi: 10.1016/j.critrevonc.2025.104631. Online ahead of print.

Authors

Eric J Lehrer¹, Chachrit Khunsriraksakul², Sara Garrett², Daniel M Trifiletti³, Jason P Sheehan⁴, Matthias Guckenberger⁵, Alexander V Louie⁶, Shankar Siva⁷, Piet Ost⁸, Karyn A Goodman⁹, Laura A Dawson¹⁰, Leila T Tchelebi¹¹, Jonathan T Yang¹², Timothy N Showalter¹³, Henry S Park¹⁴, Daniel E Spratt¹⁵, Amar U Kishan¹⁶, Gaorav P Gupta¹⁷, Chirag Shah¹⁸, Stefano Fanti¹⁹, Jeremie Calais²⁰, Ming Wang²¹, Kathryn Schmitz²², Dajiang Liu²³, John A Abraham²⁴, Robert T Dess²⁵, Irène Buvat²⁶, Benjamin Solomon²⁷, Nicholas G Zaorsky²⁸

Affiliations

¹ Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. Electronic address: ericjlehrer@gmail.com.
² Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.
³ Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
⁴ Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
⁶ Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁷ Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
⁸ Department of Human Structure and Repair, Ghent University, Belgium; Department of Radiation Oncology, Iridium Network, GZA Ziekenhuizen, Wilrijk, Belgium.
⁹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ Department of Radiation Oncology, University of Toronto, Ontario, Canada.
¹¹ Department of Radiation Oncology, Northwell Cancer Institute, Lake Success, New York, NY, USA.
¹² Department of Radiation Oncology, New York University School of Medicine, New York, NY.
¹³ Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
¹⁴ Department of Therapeutic Radiology, Yale University, New Haven, CT, USA.
¹⁵ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
¹⁶ Department of Radiation Oncology, University of California Los Angeles, CA, USA.
¹⁷ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
¹⁸ Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, PA, USA.
¹⁹ Department of Diagnostic Radiology, IRCCS AOU, Bologna, Italy.
²⁰ Department of Molecular and Medical Pharmacology, University of California Los Angeles, CA, USA.
²¹ Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
²² Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
²³ Department of Public Health Sciences, Penn State College of Medicine, Hershey PA, USA.
²⁴ Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
²⁵ Department of Radiation Oncology, University of Michigan, MI, USA.
²⁶ Laboratory of Translational Imaging in Oncology, Institut Curie, Inserm, PSL University, Orsay, France.
²⁷ Department of Medical Oncology, University of Melbourne - Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
²⁸ Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: nicholas.zaorsky@uhhospitals.org.

PMID: 39864534
DOI: 10.1016/j.critrevonc.2025.104631

Abstract

There is a much debate regarding optimal selection in patients with metastatic cancer who should undergo local treatment (surgery or radiation treatment) to the primary tumor and/or metastases. Additionally, the optimal treatment of newly diagnosed metastatic cancer is largely unclear. Current prognostication systems to best inform these clinical scenarios are limited, as all metastatic patients are grouped together as having Stage IV disease without further incorporation of patient and disease-specific covariates that significantly impact patient outcomes. Therefore, improving current prognostic scoring systems and incorporation of these covariates is essential to best individualize treatment for patients with metastatic cancer. In this narrative review article, we provide a detailed review of prognostication systems that can be used for both the site of metastasis and primary site to best tailor treatment in these patients. Additionally, we discuss the incorporation and ongoing developments in radiographic, genomic, and biostatistical techniques that can be used as prognostication tools.

Keywords: Radiation treatment; local treatment; metastases; oligometastases; surgery.

Publication types

Review