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Oct 6, 2020 01:24PM
BevJen, Yes - I think that local treatment is "new" though may of us wonder what took them so long. And to clarify, it is my understanding that excision is considered optimal but SRS is also very promising. I have had a few attempts at local treatment. Fortunately, my insurance agreed to pay for an attempt at ablation of a liver met - I guess that was in 2019. Many people reported to me at the time that their insurance had refused to pay for such treatment because it was deemed "experimental." I think that is a large part of the problem. Insurance gets in the way, at least in the U.S. But we also need clinical trials. Once there is decent evidence, I think insurance will be on board because, frankly, it's cheaper than the outrageous chemo prices we pay in the U.S... unless they;d just rather we die as expeditiously as possible which is also a possibility. Recent literature on radiation (SRS) is very encouraging. And I was aghast when my radiation oncologist said he thought he could get me 5 more years with CyberKnife to my liver. Nobody goes out on a limb and give numbers like that. And to someone with mets!?!? I will get my first post CyberKnife scan of liver ... probably later this month. My labs have been good and I am hoping for good news.
I posted this very encouraging article earlier this year about SRS of oligomets. Note the OS and PFS stats. They are very good.:
Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial
PURPOSE The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long-term disease control, or even cure, if all sites of disease can be ablated. However, long-term randomized data that test this paradigm are lacking.
METHODS We enrolled patients with a controlled primary malignancy and 1-5 metastatic lesions, with all metastases amenable to stereotactic ablative radiotherapy (SABR). We stratified by the number of metastases (1-3 v 4-5) and randomized in a 1:2 ratio between palliative standard-of-care (SOC) treatments (arm 1) and SOC plus SABR (arm 2). We used a randomized phase II screening design with a primary end point of overall survival (OS), using an a of .20 (wherein P , .20 indicates a positive trial). Secondary end points included progression free survival (PFS), toxicity, and quality of life (QOL). Herein, we present long-term outcomes from the trial.
RESULTS Between 2012 and 2016, 99 patients were randomly assigned at 10 centers internationally. The most common primary tumor types were breast (n 5 18), lung (n 5 18), colorectal (n 5 18), and prostate (n 5 16). Median follow-up was 51 months. The 5-year OS rate was 17.7% in arm 1 (95% CI, 6% to 34%) versus 42.3% in arm 2 (95% CI, 28% to 56%; stratified log-rank P5.006). The 5-year PFS rate was not reached in arm 1 (3.2%; 95% CI, 0% to 14% at 4 years with last patient censored) and 17.3% in arm 2 (95% CI, 8% to 30%; P 5 .001). There were no new grade 2-5 adverse events and no differences in QOL between arms.
CONCLUSION With extended follow-up, the impact of SABR on OS was larger in magnitude than in the initial analysis and durable over time. There were no new safety signals, and SABR had no detrimental impact on QOL.
J Clin Oncol 38. Accepted on May 5, 2020 and published at ascopubs.org/journal/jco on June 2, 2020: DOI https://doi.org/10.1200/JCO.20.00818
"We must be willing to let go of the life we have planned, so as to have the life that is waiting for us." "If adventures will not befall a young lady in her own village, she must seek them abroad." "Buy the ticket, take the ride."
2015, DCIS/IDC, Right, 3cm, Stage IIA, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC)
1/13/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
1/14/2016 Herceptin (trastuzumab)
2017, IDC, Stage IV, metastasized to liver, ER-/PR-, HER2+