radiation of oligometastasis

Portal Forums Radiation Oncology Radiation for Distant Metastases radiation of oligometastasis

This topic contains 6 replies, has 3 voices, and was last updated by  rp25 1 year, 6 months ago.

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May 7, 2016 at 5:03 am  #1273948    

rp25

My treatment plan includes SBRT of a small metastasis (1 cm) considered to be “oligo”.
However, due to targeted therapy, it has already disappeared.
I understand there might be microscopic disease left.
Assuming the oligo area is well defined, is SBRT still an option ?
The goal would then be to kill the disease on microscopic level at an early stage.
Thanks for any comments (pros and cons etc).

May 7, 2016 at 7:55 am  #1273950    

cards7up

More info might be helpful. Type, stage and location. Have you had any other treatment?
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

May 7, 2016 at 8:09 am  #1273951    
JimC Forum Moderator
JimC Forum Moderator

Hi rp25,

Welcome to GRACE. Congratulations on the good response to targeted therapy. Usually an oligometastatic nodule is treated when it’s the only location not responding to treatment, while yours seems to have responded well. If that metastasis has “disappeared”, I’m not sure how the radiation would be targeted. In addition, the goal of systemic treatment such as the targeted therapy you have received is to kill micrometastases wherever they may be found.

You haven’t mentioned where this nodule is located, or how well the primary tumor has responded to treatment. Those might be factors as well. If the rest of the disease is under control, then SBRT might be an option if the targeting issue can be resolved. You can find the most recent GRACE podcast here, and it includes links to other posts on the subject.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

May 7, 2016 at 10:09 am  #1273953    

rp25

Thanks Judy and JimC for your comments.
Stage IV, NSCLC, adenocarcinoma.
The plan was to start with targeted therapy and, if stable, add radiation therapy (now under consideration).
The primary tumor is located in the right lung. It has shrunk substantially but has not disappeared.
The metastasis was located on the lower part of a shank of the adrenal gland. So it might be possible to target the SBRT towards this area.

May 8, 2016 at 11:57 am  #1273966    
JimC Forum Moderator
JimC Forum Moderator

Hi rp25,

That’s great that the primary tumor has reduced in size so significantly. In that context, it seems reasonable to radiate the area of the adrenal metastasis, although of course it won’t be possible to judge its efficacy, since apparently nothing appears there on the current scan.

Good luck!

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

May 8, 2016 at 1:45 pm  #1273969    

cards7up

Is the adrenal met still visible on the CT scan? As Jim mentioned, if it’s not seen how would they radiate it? Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

May 9, 2016 at 2:07 am  #1273978    

rp25

Thanks Judy and JimC.
My understanding is that you need to replace the met with another target. In this case, the met was located in a specific part of the gland. This part could be irradiated if it is a well defined structure (using image guided RT).

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