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