Metastatic program at UF Shands - 1254941

Hallo Shane. Sorry to hear about your father's diagnosis, but glad he is doing so well.
Just to clarify, where are the metastases you refer to? Are they brain mets, or mets elsewhere in the body?

Hi Shane, Welcome to Grace. I believe we have a handful of blog/posts that will explain what is known and what is being research in the area of metastatic nsclc. The most important idea about stage IV nsclc is to prolong life while either maintaining quality of life or improving it. Since your dad is feeling so well then it sounds as if you want to maintain stability. What the cancer center is suggesting is not standard of practice but is being studied.

I will leave you with some links that state what some of the experts and researchers are doing. Read through them, look at the further reading options at the end of the posts, check out our "Focused Cancer Info" and our search engine, and by all means ask follow up questions. Note that when using our search you may need to log off depending on your browser, this goes for search results too.

All the very best,
Janine
forum moderator

A note on working outside the "standard" box, http://cancergrace.org/lung/2008/11/01/wirb-beyond-evidence/

Why radiating all the bone mets isn't standard practice. and the further reading and additional links I think cover most of what's been written in Grace blog/posts on the subject. Very informative, http://cancergrace.org/cancer-101/2011/01/01/cancer-101-faq-i-have-meta…

Shane,

I and just about all lung cancer experts agree with your oncologist that there would be somewhere between incredibly little and absolutely no value at all to focal radiation to 8 lesions. There isn't anything magical about two lesions, but the concept of "oligometastatic", which you can find plenty of discussions about here, is that there MIGHT be some value to doing local therapy if someone has an extremely limited amount of metastatic disease that is active. That isn't to say that there's actually good evidence to say it should be done...it's potentially just the prevailing bias that more is better, and it doesn't hurt that the US system pays to do more treatment, so doctors and institutions are incentivized to not just treat to the point of what makes sense, but to treat well beyond that point if it's profitable.

So basically, if it could potentially be sensible to do local therapy for oligometastatic disease, that makes far more sense for one lesion than more than one, and you might possibly torture the definition of oligometastatic to include 2 or 3 lesions, but beyond that, it's not remotely oligometastatic -- it's just metastatic. And there is no evidence or even clear rationale to think that treating 5 or 8 or 10 lesions with localized therapy for metastatic lung cancer is a good idea, unless your goal is to get paid to do more and more and more therapy, no matter how bad an idea it is.

Please note that I don't have anything to do with UF Shands and am nearly 3000 miles away. I don't have a horse in this race. I'm not saying that the UF Shands is just doing this program to make money, but I'd bet anything that if they weren't getting paid well to do it, they wouldn't have a remote interest in doing it as a charitable service for needy patients. I don't know if the underlying incentive is financial motivate or an absence of any knowledge of cancer biology. But the only reason to market this is greed or ignorance.

-Dr. West

Shane,

A few years ago, Dr. Pinder did a piece on stereotactic radiation for oligometastatic disease based on work by Dr. Paul Okunieff just about the time when he left Florida to lead UF Shands. You might find it interesting and can find it at http://cancergrace.org/radiation/2009/12/06/well-knock-me-over-with-a-p…

Stereotactic radiation for oligometastatic disease has never been proven to help. Those who are enthusiastic about it will point to small case series like the one Dr. Pinder shows that have a "tail" to the curve of patients with longer survival than typical for their diseases. Those who disagree will point to older case series without sbrt that also have tails and argue that some patients would do well no matter what we do.

Perhaps the most important point is Dr. West's regarding the definition of oligometastatic disease. Different series have argued it differently, but I'm not aware of a major published report that used a number higher than 5. Above that point, most docs just consider it systemic.

One final point worth discussing is what the downsides to the radiation are. Potential side effects and risks are largely defined by the size of the lesions and their locations; the radiation oncologist can counsel about this. What are the financial expenses? It's one thing to go broke for proven or even very promising therapy, but another to do so for very unproven non-conventional therapy.