Radiation of metastases now makes more sense?

[cigafred]

"The evolution and rise of Stereotactic Body Radiotherapy (SBRT) have been particularly notable in patients with oligometastatic disease, where it has been demonstrated to be a safe and effective treatment strategy yielding favorable results in terms of disease control and improved oncological outcomes." Does this mean that it now makes more sense to radiate metastases?

urotoday.com/recent-abstrac...

[StayingOptimistic]

Some very knowledgeable guys on here think that there is no proven trials that it makes big difference.

[cigafred in reply to StayingOptimistic]

But this is new information, so . . .

[Mascouche]

This link contains a more fleshed out version that the article is summarizing: frontiersin.org/journals/on...

[cigafred in reply to Mascouche]

Excellent, thanks. The paper states that "If confirmed in future research, these results would therefore open new horizons for radiotherapy applications in the clinics, and BgRT may emerge as a valuable tool for the treatment of all metastatic sites with ablative doses in cases of polymetastatic cancer." I need to improve my understanding of BgRT vs SBRT. I have been assuming that BgRT is a subset of or new way to use SBRT, but in some cases that does not seem to be the case. Anyway, it does seem that the SOC assumption that radiating metastases needs trials using BgRT.

[Tall_Allen]

Nothing new here. Debulking of the prostate is beneficial when there are 3 or fewer metastases on a bone scan. There is no convincing evidence that SBRT to oligometastases has any oncological benefit. But if safe, why not?

[cigafred in reply to Tall_Allen]

Thank you sir. I used subjunctive words like "seems" and "if." The paper quoted is certainly recent, 8 Sept 2024, so in my opinion the conculsion in the paper that " BgRT may emerge as a valuable tool for the treatment of all metastatic sites with ablative doses in cases of polymetastatic cancer" is valid. Where I need to do more research is the relationship between BgRT and SBRT. (My wife has had SBRT and I turned down SBRT for IMRT for my lymph nodes more than ten years ago.)

[Tall_Allen in reply to cigafred]

"in my opinion the conclusion in the paper that " BgRT may emerge as a valuable tool for the treatment of all metastatic sites with ablative doses in cases of polymetastatic cancer" is valid. " It's just an opinion piece. You may as well agree that we will have men on Mars in ten years - there is about as much evidence for either statement.

[Brianne07 in reply to Tall_Allen]

Hi I have bee]n following you for a couple of years just checking how your going? Regards brian

[Concerned-wife]

my husband is facing this dilemma now. He has a met in the lower pubic ramus but has had radiation of his prostate previously so the calculations of safe radiation to avoid urinary issues are more difficult. My husband had considered just resuming the drugs and not risking the radiation, however, His consulting, well known, MO said he could try stopping the drugs again if he had radiation and Undectable PSA after 6 months of the drugs..he advised there is only 30% chance that this might be curative from his interpretation of the studies. The consultant MO advised Lifetime drugs if he doesn’t do the radiation.

[Manilo in reply to Concerned-wife]

I would go for the SBRT ASAP if it were my case

[Concerned-wife in reply to Manilo]

30% chance of going back off drugs seems worth it but the possible , serious urethral complications are of concern..waiting to hear from the RO to see what % chance there is of complications after he does his planning.

[Manilo]

I have been seeking doctors to radiated metástasis all alone. Most did not want to because of protocols. But I got all of them radiated. And now it will be a protocol to radiated mets.

[Seasid in reply to Manilo]

"It sounds like you've been proactive in getting all your metastases radiated, even when it went against standard protocols at the time. Your persistence paid off, and now radiating metastases is becoming more accepted as part of treatment protocols. This shift likely reflects growing evidence that treating metastases with radiation can improve outcomes in certain cancers, including prostate cancer. It's impressive that you pushed for this treatment and were ahead of the curve in adopting a now-recognized approach."

ChatGPT comments

[old64horn]

I had SBRT no a prostate tumor in my left lung, Prior to the radiation, my PSA was 1.06. 2 weeks after SBRT in was <.06. I consider this to be a good result that can postpone ADT.

[EdBar]

I’ve had my prostate debulked with radiation early on after dx and PSA was undetectable for 6-7 years. When it became detectable a couple of times in the last couple of years a PSMA scan showed a met on a rib which was treated usin SBRT each time my PSA fell back to nearly undetectable. Dr. Sartor said I can continue using this strategy indefinitely depending on the location and number of tumors. In my opinion SBRT is probably the easiest treatment I’ve undergone.

Ed

[Mascouche in reply to EdBar]

When you had SBRT on those met, was it by itself or was it accompanied by ADT? If it was not accompanied by ADT, what was your MO's rationale?

In my case, when a met was found on my right shoulder blade after 13 months of ADT vacation from my previous curative intent treatment, I was given 3 radiation sessions accompanied by Orgovyx and Xtandi. My RO wants me on ADT for life, my MO asked me to take ADT for 9 months and I've told him that I'll do ADT until NADIR plus 2 months because I don't want to take ADT forever if I can zap a met every couple of years instead.

[cigafred in reply to Mascouche]

I started ADT and lymph node radiation at the same time. I should have waited a bit on the radiation, but I did not have the patience. The radiation was my plan, my MO had the view of Tall Allen, "if safe, why not?"

[EdBar in reply to Mascouche]

I’ve been on ADT since day one for over 10 years.

[cigafred in reply to EdBar]

You win: 9.5 years here

[Vangogh1961]

I'm in a trial at MD Anderson that did the pelvis and was randomized into the arm that did the thoracic spine spot.

[SpencerBoy11]

Just my reminder 2 cents regarding radiation which seems never mentioned: radiation can cause a blood cancer, Myloidesplastic Syndromes (MDS). While a rare condition, it will kill you quicker. I'm there.

[LifeQuality]

What is unclear to me about many of the responses to your post is WHY men reported choosing radiation. Is it because of pain at the metastasis? Or is it because the location shows up on a scan and they want to "kill it"? I have had one spot radiated--my lower skull--because it developed 24/7 pain. The radiation was very effective--it has totally stopped the pain, and my latest scan shows that the spot has shrunk. But I'm hesitant to choose radiation absent pain, due to the known connection between more radiation and more cancers.

[Mascouche in reply to LifeQuality]

It's an understand concern. In my view, I think it is because the concern about dealing with the cancer that is already there trumps the concern about potentially having to deal with another cancer in the future.

[Manilo in reply to LifeQuality]

I asked for SBRT to all 4 spine mets.One was painful

I combined it with pembrolizumab and ivermectin

In the past I had other prostate and lymph and bone met, treated with Lu177, and Bone with SBRT after Lu177 did not kill it.

Now I am doing BAT 1st cycle. No signs of mets but suspicious spot in Prostate. I am off Enza since 2 months ago, today I take my 2nd Testosterone injected

[Rickmartin1948]

I had a couple of Mets radiated (SBRT) on my left hip bone where I was suffering from severe pain and it was worth in terms of quality of life. It did not cure me, still on Orgovyx but my life improved a lot

[Rocketman1960]

Have had SBRT twice over the past 6 years to goxafter lymphatic areas. One in the lung area, 2 in the prostate bed area. Worked like a champ to lower tumor burden.