Oligometastasis as a predictor for occult disease

Kendal, Wayne S.

doi:10.1016/j.mbs.2014.02.006

Cited by 16 publications

(25 citation statements)

References 39 publications

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“…Most previous studies limit the scope of MDT to three synchronous lesions, given that the likelihood of occult metastases increases as the number of detectable lesions increases. 17 However, our data shows that treating 4-5 synchronous PCa lesions with SBRT is just as effective as treating 1-3 lesions in terms of treatment escalation status at 2 years and TE-FS. This approach is likely to be most effective when PSMA-PET is used for staging.…”

Section: Discussionmentioning

confidence: 63%

“…The number of oligometastatic PCa lesions considered amenable to MDT remains contentious and this is an important aspect of our study. Most previous studies limit the scope of MDT to three synchronous lesions, given that the likelihood of occult metastases increases as the number of detectable lesions increases . However, our data shows that treating 4–5 synchronous PCa lesions with SBRT is just as effective as treating 1–3 lesions in terms of treatment escalation status at 2 years and TE‐FS.…”

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

Fractionated stereotactic body radiotherapy for up to five prostate cancer oligometastases: Interim outcomes of a prospective clinical trial

Bowden¹,

See²,

Frydenberg

et al. 2019

Intl Journal of Cancer

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Stereotactic body radiotherapy (SBRT) can delay escalation to systemic treatment in men with oligometastatic prostate cancer (PCa). However, large, prospective studies are still required to evaluate the efficacy of this approach in different patient groups. This is the interim analysis of a prospective, single institution study of men relapsing with up to five synchronous lesions following definitive local treatment for primary PCa. Our aim was to determine the proportion of patients not requiring treatment escalation following SBRT. In total, 199 patients were enrolled to receive fractionated SBRT (50 Gray in 10 fractions) to each visible lesion. Fourteen patients were castration resistant at enrolment. The proportion of patients not requiring treatment escalation 2 years following SBRT was 51.7% (95% CI: 44.1–59.3%). The median length of treatment escalation‐free survival over the entire follow‐up period was 27.1 months (95% CI; 21.8–29.4 months). Prior androgen deprivation therapy (ADT) predicted a significantly lower rate of freedom from treatment escalation at 2 years compared to no prior ADT (odds ratio = 0.21, 95% CI: 0.08–0.54, p = 0.001). There was no difference in the efficacy of SBRT when treating 4–5 vs. 1–3 initial lesions. A prostate‐specific antigen (PSA) decline was induced in 75% of patients, with PSA readings falling to an undetectable level in six patients. No late grade three toxicities were observed. These interim results suggest that SBRT can be used to treat up to five synchronous PCa oligometastases to delay treatment escalation.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 67%

Fractionated stereotactic body radiotherapy for up to five prostate cancer oligometastases: Interim outcomes of a prospective clinical trial

Bowden¹,

See²,

Frydenberg

et al. 2019

Intl Journal of Cancer

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“…It follows that variability in each of these factors could lead to tumors with varying potential for metastatic progression, including groups of tumors with a low propensity for metastasis, a premise supported by multiple preclinical models (28). Bayesian modeling suggests that in patients with oligometastases, the likelihood of occult metastatic disease increases rapidly with even small increases in metastatic potential (32).…”

Section: On the Horizonmentioning

confidence: 99%

New Strategies in Stereotactic Radiotherapy for Oligometastases

Palma

Louie

Rodrigues

2015

Clinical Cancer Research

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Patients with metastatic solid tumors are usually treated with palliative intent. Systemic therapy and palliative radiation are often used, with the goals of prolonging survival or maintaining quality of life, but not of cure. In contrast to this paradigm, the theory of oligometastasis suggests that some patients who have a small number of metastases may be amenable to cure if all lesions can be eradicated. Aggressive treatment of patients with oligometastases, using either surgery or radiotherapy, has become more common in the past decade, yet in most situations, no randomized evidence is available to support such an approach. Stereotactic ablative radiotherapy (SABR) is a novel treatment for oligometastases, delivering large doses of radiotherapy in only a few treatments, with excellent rates of local control, and appears to be an excellent noninvasive alternative to surgical resection of metastases. This article reviews recent biologic and clinical data that support the existence of the oligometastatic state and discusses gaps in this evidence base. The emerging role for SABR in the management of this challenging patient population is discussed with a focus on ongoing clinical trials in an attempt to improve overall survival, delay progression, or induce immunologic anticancer effects through the abscopal effect.

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“…Given that stochastic models have been used to predict biologic phenomena, a Bayesian model has been proposed to predict the chance of occult metastases in the presence of detectable oligometastases [ 31 ]. Using the size and number of metastases, the proposed model inferred, (1) that the probability of occult metastases may increase substantially with minor increases in metastatic potential and (2) that extended disease-free periods were predictive of a substantial decrease in additional occult disease.…”

Section: Introductionmentioning

confidence: 99%

“…Although compelling, such models are in their infancy and as yet remain in pre-clinical testing where the host, tumor and experimental factors are controlled. [ 31 ]…”

Section: Introductionmentioning

confidence: 99%

The biology and treatment of oligometastatic cancer

2015

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Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.

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Oligometastasis as a predictor for occult disease

Cited by 16 publications

References 39 publications

Fractionated stereotactic body radiotherapy for up to five prostate cancer oligometastases: Interim outcomes of a prospective clinical trial

Fractionated stereotactic body radiotherapy for up to five prostate cancer oligometastases: Interim outcomes of a prospective clinical trial

New Strategies in Stereotactic Radiotherapy for Oligometastases

The biology and treatment of oligometastatic cancer

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