Trial Comparing Standard of Care Therapy With and Without Sequential Cytoreductive Intervention for Patients With Metastatic Foregut Adenocarcinoma and Undetectable Circulating Tumor-Deoxyribose Nucleic Acid (ctDNA) Levels

Inclusion criteria

• ✓. Up to five pulmonary metastases amenable to wedge resection (maximum of three wedge resections) or lobectomy (single lobectomy) or consolidative radiation/ablative therapy
• ✓. Up to five hepatic metastases amenable to hepatectomy (segmentectomy, sectionectomy, sectorectomy, minor hepatectomy, not more than three segments), wedge resection requiring a minimum of 40% of liver parenchyma following resection based on future liver remnant or a combination of partial hepatectomy and microwave ablation or trans-arterial radioembolization (TARE).
• ✓. Lymphatic metastases that are resectable or intervenable (limited to only two non-regional sites) (see Appendix 3).
• ✓. Resectable peritoneal disease with a PCI of ≤6 and the ability to obtain a CC0 cytoreduction.
• ✓. Distant metastasis must be limited to two of the above-mentioned sites (a-d).
• ✓. If both pulmonary and liver metastasis are present (a, b), then a total of five lesions will be considered oligometastatic.