Understanding the differences in types of radiation and why the ORIOLE Trial showed SBRT to be effective for Oligometastatic patients

[NPfisherman]

Hello FPC crew,

Not to be confused with 2 Live Crew...Recently, a post appeared on another forum discounting radiation for oligometastatic patients with bone metastasis as having no survival benefit... The study that was listed used EBRT, so needless to say, it is important to understand the differences in types of radiation... I have posted a site with a simplified explanation of types of radiation...see below:

targetingcancer.com.au/radi...

As you can see, there is a difference and SBRT is a newer form of radiation treatment that is still under research. What the ORIOLE trial did find was that there was an "abscopal effect" from treatment with SBRT and that those that had no untreated lesions based on a PSMA scan were much less likely to have recurrence. Another article about the ORIOLE Trial:

grandroundsinurology.com/pc...

And, of course, there is my prior post on the ORIOLE Trial which people can refer back to in regards to reviewing the trial...see below:

healthunlocked.com/fight-pr...

Calling SBRT as "whack a mole" and having no survival benefit is inappropriate... SBRT is newer and it will be some time for determination of survival benefit... What I do know is that my MO is following about 80 cases similar to mine with "hitting it hard" with initial ADT and Zytiga as well as SBRT to oligometastatic lesions, getting to "undetectable" status and staying there, and watching them going on ADT vacations. Even if there was "no survival benefit" which is not something ANYONE can say, there is the matter of QOL and not experiencing "brain fog" or "hot flashes" or gaining weight or the risks of bone deterioration, heart disease, and prolonging the period to castrate resistance. Can anyone put a value on those issues because I can not...

At any rate, I welcome questions and comments...

Don Pescado

[cesanon]

This is not logical????

I guess either it works like that or it doesn't.

But this is really strange.

I would like to hear from Tall Allen what his thoughts are.

[NPfisherman in reply to cesanon]

Why is it not logical ??...please explain...The ORIOLE trial is fact...there is no determination of survival benefit with SBRT yet...fact... do you think Grand Rounds in Urology is wrong?? Are facts illogical?? Do you think using SBRT and Zytiga plus Lupron and getting to undetectable poses no survival benefit?? What do we know about PSA nadir and survival?? I could go on from here, but...

[cesces in reply to NPfisherman]

"Why is it not logical ??...please explain"

Once the cancer metastasized, it's all over and not targetable.

Logically it is like trying to shoot flys with a cannon.

That is my thinking.

I would just like to see an affirmation that the study was well designed before adjusting my belief system.

[NPfisherman in reply to cesces]

OK....so I must believe that you did not read the post or articles....there is commentary from Dr Tran...This was a RANDOMIZED trial proving the value of SBRT in Oligometastatic patients--see below:

sciencedaily.com/releases/2...

The abscopal effect and the immune response is of value to oligometastatic patients. They are now doing the RAVENS trial using SBRT plus Xofigo...What you do in regards to your belief system is up to you...

[cesces in reply to NPfisherman]

I don't trust my ability to properly evaluate the quality of a trial. That's all.

Like most humans I am not so quick to adopt something that is at first glance counter-intuitive to me.

That's all.

[NPfisherman in reply to cesces]

Then why did you respond like this 2 days ago to a trial ??:

That is logical.

But it is also logical to use radiation if you have a growth impinging on something important, like say your spinal cord.

Your beliefs are your own. ...The RAVENS trial using SBRT for oligometastatic lesions plus Xofigo for micrometastases is recruiting-see below:

clinicaltrials.gov/ct2/show...

I doubt that an unsuccessful trial or one of mixed results would have a follow up with a combination to cover everything... Maybe you should ask Schwah or JamesAtlanta if they think SBRT works...

[cesces in reply to NPfisherman]

I didn't mean for my skepticism to offend, or for it to be interpreted as personal.

It's just given the physics involved it is hard to imagine the mechanism by which this could or should occur.

[NPfisherman in reply to cesces]

Not offended but some research on your own is indicated.

Read up on the abscopal effect...it had been hypothesized as being there but no proof....the proof is in after examination of T cells and what occurs with SABR is an enhanced T cell response similar to vaccinations. By exposing T cells to the annihilated tumor cells, neoantigens activate the T cells resulting in the abscopal effect allowing CTC's to be attacked and destroyed as well as other micrometastases over a limited period of time... Advaxis has a neoantigen type vaccine in development in their HOTS program called ADXS-504 for PCa-Phase 1. ( worth a look )

From the article below: The effect of radiotherapy on the immune system is also an area of interest with the promise of using SABR to induce an in situ vaccine response.20,31 We observed enhanced differential clonotype expansion, clusters of similar expanded T-cell receptors, and a clinical benefit to greater baseline clonality seen only in participants treated with SABR. Future studies assessing the association of these findings with T-cell characteristics or relatedness to tumor-infiltrating lymphocytes may help further characterize this systemic immune response.

ARTICLE:

ncbi.nlm.nih.gov/pmc/articl...

Think of it as a way to destroy a few tumors AND activate T cells to attack other tumors and micromets...thus, pushing disease process back...

[NPfisherman in reply to cesanon]

I guess what he says is logical and the study I posted is illogical?? I guess he is collecting his thoughts on how to respond to tango 65 on his post Targeting Bone Metastases with Radiation in Oligorecurrent Men has No Survival Benefit in Mayo Study... Have him address tango first since it has been a few days...

[cesces in reply to NPfisherman]

Of course complex biological systems often follow their own hidden logic.

Still I would love to hear his thoughts on this specific study.

[NPfisherman in reply to cesces]

Funny that you responded with your other pseudonym...Isn't one name for the forums enough?? Invented a complex system all your own...but I digress...

[Boywonder56]

I like the way you bait your hook np....i aggree qol over survival is what i know the majority of us are after ..... fat after being led to believe that there are no side effects from ADT and I did the Lupron and erleada I know the doctors will tell you anything. Thanks for the insight....may all your fish be keepers ....b.w.

[NPfisherman in reply to Boywonder56]

BW,

Thanks for your reply...I think it is wise when people understand the differences in radiation, and that comparing EBRT and SBRT is like apples and oranges...I looked at your profile and congrats on 4 years....not sure if you had SBRT, but it is worth considering if the pelvic met has grown...I believe that "hitting it hard early" will provide survival benefit, but since I am only an NP that does not do Oncology, then one must take it with a bit of salt... not unlike cooking fish...

Happy holidays,

Fish

[NPfisherman in reply to Boywonder56]

BW,

Indeed, being able to be off ADT and experience QOL--clearer thoughts, multi tasking improvements, not walking into a room and wondering what you came for, not feeling "hot flashes" or being worried about health complications... no longer being anemic and feeling "gassed" after doing strenuous work... It is nice...and only people that undergo treatment like ours can fully understand... best of luck to you on this journey...

Fish

[Boywonder56 in reply to NPfisherman]

Ty for response....and i dislike the remark...oh your just getting old.....you hit the nail on da head.....my worst bitch is weight gain..i try but by got it takes evrything i have to just get thru another day. Nice to see you surface from time to time....b.w

[NPfisherman in reply to Boywonder56]

It is a long and arduous journey....some suffer, deteriorate, and die in such a short time...it is why I follow the science to give direction and hope for others...Keep fighting...I fight the battle of the bulge also and it is a daily battle... I have a T shirt that says, "I'm not old....I am vintage"... Here's to being vintage...

Fish

[marnieg46]

Your information was very timely Dave as I read the post you mention to Ron last night and was wondering if it was relevant and whether I should put more time in pursuing...or maybe something to raise when he next sees his specialist.

What was extremely helpful were the added links back to relevant information... and in your usual style... a synthesis of the content. I've always wondered why on the forum many men mention having radiation to bone metastasis yet here in Australia it doesn't seem to get a mention and certainly hasn't been raised by our specialists as an option for Ron.

Thank you for taking the time once again to help those like me trying to make sense of the outcomes of trials and other new information that becomes available and consider their application for individual application. Your time and efforts to make things clearer very much appreciated.

[NPfisherman in reply to marnieg46]

You are most welcome, Marnie...Thank you for your acknowledgement and kind words. I am not sure the number of metastases that Ron had in the beginning off the top of my head....There is currently a SABR-COMET -10 trial for those having 4-10 lesions and if that were my case, I would pursue it...What does killing millions of PCa cells with SBRT do towards slowing the disease process. I believe it helps... a 1 cm lesion has millions of PCa cells... stop them and one might deduce that disease is slowed, but clinical trials continue with SBRT on that issue... In the meantime, may you and your clan be safe and well in Oz...

Dave

[marnieg46 in reply to NPfisherman]

My pleasure Dave. Your posts always make sense. You mention 4 - 10 lesions ...does that include lymph nodes or are they excluded from the count ?

[NPfisherman in reply to marnieg46]

It includes lymph nodes and bone...as I recall....I will message you later but here is some info on the trial:

clinicaltrials.gov/ct2/show...

Please note the locations...and a discussion with an RO is on a higher level than an NP...LOL... more later...

Dave

[marnieg46 in reply to NPfisherman]

Oh thanks. Guess that rules him out but I’ll check out info and links more carefully.

[NPfisherman in reply to marnieg46]

OK, just sent you a message.. You and Ron stay safe and be well...

Dave

[cesces]

My understanding is that the only difference between sbrt and ebrt is that sbrt is more concentrated and focused.

Is that correct?

[NPfisherman in reply to cesces]

My RO described SBRT as being like dropping a nuclear bomb on the tumor...Here is a study on the superiority of SBRT over EBRT... There is a difference in fractionation and Gys used per session in treatments..read up on these terms and the differences ...some research on your own is indicated...

ncbi.nlm.nih.gov/pmc/articl...