Met-directed therapy beneficial when less than five mets

[Purple-Bike]

From International Journal of Radiation Oncology, August 16, 2 022

In this review, the authors outline the evidence to date from clinical trials assessing the utility of radiotherapy in patients with oligometastatic prostate cancer. Primary prostate radiation in the de novo metastatic setting prolongs biochemical progression–free survival (BPFS) and may provide a survival benefit in patients with less than five bone metastases. Metastasis-directed therapy in the form of stereotactic ablative body radiotherapy (SABR) may provide benefits beyond local control in both patients with hormone-sensitive and hormone-resistant prostate cancer, including longer BPFS and radiologic PFS.

Radiotherapy, particularly SABR, should be considered in patients with oligometastatic prostate cancer. Highly-sensitive imaging modalities, such as PSMA PET, are essential to identify patients most likely to benefit from radiotherapy.

– Charles Gaulin, MBBS

[Islandboy2021]

Why limit it to only 5 Mets.

[Seasid in reply to Islandboy2021]

Very, very good question.

I believe most important is that you can radiate the mets without inflicting too much damage to be nearby organs. Maybe the numbers are not the most important.

[Purple-Bike in reply to Seasid]

I agree. It takes time before the evidence builds up. For a long time there was no proof of benefit for met-directed radiation at all. But many of us went for it anyway. Soon the evidence may well be in for benefits for a large number of mets, if not ill located as Seasid writes.

[KocoPr]

I had 5 mets and tried to get in a phase 1 clinical trial at MSK for lu-177 and SBRT.I sent all my records and spoke several times with the coordinator screeners. I was told i fit the criteria but when I drove 4 hours to get there i met with the OC and he said so you have come for a second opinion on your next course of treatment. My wife and i were dumbfounded. So we said ah no im here to get in your trial. He apologized then looked at my records and recent PSMA scan and he said i have 5 METS only 3 are allowed. This is twice this has happened once at Dana Faber and at MSK.

Oh I forgot it also happened T Weill Cornell in NYC a rucaparib phase 3 trial. another 4 hour trip except this time they put me through the ringer with bone scans, CAT scan, gazillion blood tests I never even heard of. Then they sent all my records to the coordinating hospital Johns Hopkins and they rejected me because my RAD50 gene mutation was of uncertain significance. At least I got a laugh at Penn Station when i got surrounded by Homeland Security for setting of their radiation detectors.

[billd50]

Hi, Did you refer to the study somewhere. I'd like to review it. Thanks.

[Purple-Bike in reply to billd50]

I couldnt refind the article but here is a similar one Long-Term Outcomes and Genetic Predictors of Response to Metastasis-Directed Therapy Versus Observation in Oligometastatic Prostate Cancer: Analysis of STOMP and ORIOLE Trials

Matthew P. Deek , MD1,2; Kim Van der Eecken, MD, PhD3; Philip Sutera , MD2; Rebecca A. Deek, MS4; Valérie Fonteyne, MD, PhD5; Adrianna A. Mendes, MD6; ...

[billd50 in reply to Purple-Bike]

Thanks