Is radiation treatment just palliative?

[HopingForTheBest1]

Recent PSMA and Axumin scans show two spots, one in the back area in soft tissue near the 7th rib and the other in the bone marrow in the right femur. Both small.

My MO initially recommended radiation. Two days later, at our latest in-person appointment, he told me that if I get radiation now it could disqualify me for upcoming hopeful clinical trials. He also said it is palliative, for patients who are experiencing pain which I am not currently.

Right now I feel like I am caught between a rock and a hard place. I do have several telemed appointments coming up in the next several days, with a 2nd Rad Onc and two clinical trial Principal Investigators at NY Presb and Weill Cornell. Then I hope I will have sufficient info to make the "right" decision, if there is such a thing.

[GP24]

When bone mets cause pain you can radiate these with three fractions and usually this reduces the pain. This is palliative radiation. In your case there is only one spot in the bone and one in soft tissue. Only the one in the bone can cause pain. So there is no need to radiate the bone met now. If you want to get rid of these spots, you can have them radiated with SBRT radiation which will usually remove them. This is not palliative then. As new mets will appear, you should combine this with systemic therapy.

[HopingForTheBest1]

I always appreciate your input.

[Tall_Allen]

Yes, as far as we know, radiation to metastases has no oncological benefit - it is palliative. That's as far as we know. My opinion is that if it in a safe place to irradiate, why not? But which clinical trials are you considering that it would disqualify you for?

[HopingForTheBest1 in reply to Tall_Allen]

I will know after my upcoming telemed calls this Wednesday and Thursday.

[HopingForTheBest1 in reply to Tall_Allen]

Columbia Presbyterian is recommending - clinicaltrials.gov/ct2/show...

Combo of REGN5678 and Cemiplimab

Appreciate your thoughts.

[Tall_Allen in reply to HopingForTheBest1]

I'm very hopeful about BiTE therapy!

[Chask]

I am currently failing Zytiga and had a PSMA scan which showed only 2 mets. One on my right scapula and the other on my 8th rib.

I asked about SBRT (thanks to the bright people on here who had mentioned SBRT as a possibility for Oligometastatic situations). Onco agreed and ironically said that could help with my participation in future clinical trials as they often excluded men who had previous chemo, so avoiding chemo now could be good.

Interestingly, the radiation Onco said that they “usually” only used SBRT for pain relief, but was happy to do it on me, but was very ambivalent about it’s effect on overall survival, so really only seeing it as palliative rather than curative.

Chas

[HopingForTheBest1 in reply to Chask]

Thanks. This is helpful. We appear to be on similar paths.

Have any specific trials been recommended for you to pursue? Also, has Xofigo been discussed as a follow-up systemic treatment to radiation?

[Chask in reply to HopingForTheBest1]

No specific trial that I know of but pretty sure my Oncologist had a future trial in mind that he is working on, maybe something to do with immunology. But note that I am in Australia so our available trials will be different. No mention of Xofigo yet, and being Oligometastatic, I prefer the option of SBRT and see where that takes me.

[Break60]

I had SBRT to three bone mets( see profile) with no recurrence. I also switched to estradiol as systemic tx. I haven’t looked back! Can’t see stopping radiation in order to “qualify” for Clinical trial! Deal with what you have dude.

[Chask in reply to Break60]

Gee Break60, that is a great outcome. I can only hope for something similar after my SBRT. Interesting to see that we both had similar mets, scapula and rib, though I don’t have the femur one (yet!).

[j-o-h-n]

go across the street to sloan....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/19/2021 6:49 PM EST

[raoulmaherUK]

Unfortunately I am led to believe,it’s not a curative treatment by oncologist and may even cause additional cancers sometime down the road kindest Raoul

[Rodeoz15]

My father's MO also asked us to take an RO opinion who has recommended SBRT to the two mets in bones which are still avid. And IGRT to the prostate. My father has no bone pain. We are still considering whether radiation right now is useful considering ADT has been working very well for him.

Rationale given for SBRT was to prevent potential fractures.

[Javelin18 in reply to Rodeoz15]

I had radiation to a bone met that was protruding into the fluid area behind the spinal column. It was causing referred pain in my ribs. They treated it to prevent further growth into the spinal column.

In the meeting with the orthopedic surgeon, prior to treatment, he said that there was a risk of fracture from the radiation, but the risk of fracture was greater if I didn’t treat it.

[CAMPSOUPS in reply to Javelin18]

Seems palliative AND preventive. Preventive in terms of structural damage.Hope all is well in that regard since tx.

[Javelin18 in reply to CAMPSOUPS]

The single dose cleared up the problem, so I’m happy with that. Now I just need to get rid of the rest of the cancer.

[Rodeoz15 in reply to Javelin18]

Thank you. This was helpful to know.