Kendra Harris, MD, MSc
Department of Radiation Oncology
Tulane University School of Medicine
An increasing amount of evidence shows that a proportion of patients with cancer found to have low-volume metastases at diagnosis see meaningful benefit from aggressive local therapy. Equally important, there have been no meaningful reductions in reported quality of life among patients receiving intensive local therapy, and a small percentage of patients appear to be cured with this strategy.
Table. Clinical Trials Assessing Aggressive Local Therapy WITH SBRT1-3
In STOMP, a published prospective randomized multicenter trial for men with prostate cancer with a low number of metastases, the use of SBRT or metastasectomy doubled the time to next line of therapy (in this case, androgen blockade) from 13 months to 21 months. Again, it was important that quality of life was similar between arms at 3 months and 1 year, meaning that aggressive local therapy was not associated with meaningful negative adverse effects.2
Follow-up for this trial is ongoing.
Such trials are game changers for patients. At Tulane University School of Medicine’s Department of Radiation Oncology, SBRT helps our patients pursue their best possible outcomes. And for the right patient, even when the promise of possible cure is not within reach, SBRT management of active localized disease can preserve quality of life by delaying systemic therapy intensification.
- Palma DA, Olson RA, Harrow S, et al. Stereotactic ablative radiation therapy for the comprehensive treatment of oligometastatic tumors (SABR-COMET): results of a randomized trial. Int J Radiat Oncol Biol Phys. 2018;102(3)(suppl):S3-S4. doi: 10.1016/j.ijrobp.2018.06.105.
- Ost P, Reynders D, Decaestecker K, et al. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol. 2018;36(5):446-453. doi: 10.1200/JCO.2017.75.4853.
- Chmura SJ, Winter KA, Salama JK, et al. NRG BR002: a phase IIR/III trial of standard of care therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical ablation for newly oligometastatic breast cancer. J Clin Oncol. 2017;33(suppl 15). doi: 10.1200/jco.2015.33.15_suppl.tps1105.
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