What is Metastasis?
Metastasis is spread of a cancer away from the original site where the cancer began. Many patients diagnosed with cancer either present with or will develop metastasis. Generally, metastatic cancers are considered incurable with a linear recommendation for systemic therapy to delay progression and management of symptoms. However, our understanding of survival outcomes for metastatic cancers is being radically altered based on promising results of recent studies.
Exciting News For Metastatic Patients
The STAMPEDE trial, a large UK based study, is a landmark clinical study challenging the standard approach in the treatment of metastatic prostate cancer. In this trial, radiation therapy to the prostate was given even though the patients had metastasis of cancer. The investigators found that patients who received radiation therapy to the prostate had an improved chance of survival. This is exciting news for men with locally advanced, recurrent and metastatic prostate cancer.
Such results are not limited to prostate cancer; emerging evidence is challenging the conventional approach for other metastatic (stage IV) cancers such as colorectal and breast. For example, colon cancer case studies show 5-year survival rates after resection of liver metastasis ranging from 24 to 58 percent.
It is important to note that the patients in these studies were highly selected. Stage IV cancer is perhaps the most heterogeneous of cancer stages. The so called ‘oligometastatic’ cancer is a distinctive subset of metastatic cancer characterized by a single or few (usually ≤ 5) detectable metastatic lesions. A curative treatment approach is generally limited to patients that meet this criterion.
Our improved understanding of the genetics of cancer has led to breakthrough advancements with new types of systemic therapy. These new systemic therapies specifically target the tumor or help reprogram your own body’s immune system to fight cancer. They can even work in conjunction with radiation therapy to improve outcomes. For example, shortened courses of radiation therapy such as SBRT can help immune therapies to better target the cancer.
Successful treatment outcomes of oligometastatic cancer is creating a shift from symptom management to potential cure for these patients. This combination of better systemic therapy along with more aggressive local therapy with radiation and surgery is transforming what was previously possible in cancer treatment.
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