Oligometastatic PCa

[pjoshea13]

I had radiation on a solitary osteoblastic lesion at L5 last year. No proof at all that I qualify as an oligometastatic case (<5-6 mets), but my radiologist thought it reasonable to treat it as such. He did warn that there were no studies related to any survival advantage.

This morning, a new paper on PubMed, on the treatment of "solitary bone only metastasis" [1].

& now, a new vblog post from the bearded one - Dr Myers. He warns that the PSA doubling time is a factor in success, so perhaps I wasn't an ideal case. But it's refreshing to hear that, although the oligo case is not the norm, those patients can do well. I think that it's common to think that the cancer is everywhere once a single met is found.

askdrmyers.wordpress.com/20...

(Myers has at least one other post on the subject of oligometastatic treament.)

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/269...

J Orthop Sci. 2016 Feb 24. pii: S0949-2658(15)00115-3. doi: 10.1016/j.jos.2015.12.005. [Epub ahead of print]

Clinical outcome for patients of solitary bone only metastasis.

Hosaka S1, Katagiri H2, Honda Y2, Wasa J2, Murata H2, Takahashi M2.

Author information

Abstract

BACKGROUND:

Solitary bone only metastasis (SBOM) is a rare condition in which metastasis is limited to a single skeletal lesion originating from a previously treated or controllable primary lesion. The study objective was to evaluate the clinical features and survival regarding this rare condition and to clarify its treatment strategy.

METHODS:

A total of 1453 patients with bone metastasis registered in our hospital database were enrolled. To assess the primary and/or metastatic lesion we used plain X-ray images, CT, MRI and FDG-PET scans as well as bone scans.

RESULTS:

Among the patients, only 27 (1.8%) had SBOM. The primary cancers responsible for SBOM were lung in seven patients, breast in five, kidney in four, prostate in two, uterus in two and other types in seven. Treatment of SBOM involved resection in four patients, radiotherapy only in 17, radiotherapy in combination with zoledronate in six and chemotherapy with zoledronate in one. Local recurrence did not develop in the four cases treated with resection. However, in-field recurrence was found in 4 of 22 (18%) patients who underwent radiotherapy. All three patients who received >40 Gy did not develop in-field recurrence. The overall and event free survival rates at 5 years were 63% and 41%, respectively.

CONCLUSIONS:

Solitary bone only metastasis should be treated with wide resection or long-course radiotherapy at doses 40-50 Gy to achieve long lasting local tumor control.

Copyright © 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

PMID: 26922286 [PubMed - as supplied by publisher]

[Darryl Partner]

Do you feel any pain from the lesion?

[pjoshea13 in reply to Darryl]

No pain at all. So there was no paliative intent. Essentially, the radiation was done because (a) I asked, & (b) was referred to a radiologist who was sympathetic. He only agreed to do it because there was the single met.

-Patrick

[tarhoosier]

You have one metastasis which is fewer than 5 or 6. That makes you oligometastatic mathematically by my reasoning. Am I missing something

[pjoshea13 in reply to tarhoosier]

My radiologist doesn't treat oligometastatic PCa, as such. He said that his work was split between primary treatment, salvage radiation & palliation. He was comfortable with a solitary bony lesion. Perhaps I might have been able to press him to treat two, but this was new ground for him.

From his perspective, it wasn't clear that I would benefit, but he sympathized with my point of view. From my perspective, I was dealing with L5 before it deteriorated. Preemptive palliation, if you will.

My GP was surprised that I had radiation without first having pain. I suppose the concept will take time to catch on. Which means that patients who feel that they are candidates have to be doing the pushing.

-Patrick

[tarhoosier]

I will avoid using the term oligo... when I speak to my rad-onc.