Radiating tumors

[Joan M]

An article from University of Florida News:

Targeting tumors may help stop spread of breast, other cancers


GAINESVILLE, Fla. — Cancer that has spread from the site of an original tumor to other places in the body is often viewed as problematic. But if there are just a few of those secondary tumors, called metastases, some patients have a good chance of survival if treated with a type of radiation that precisely targets small tumors, researchers at the University of Florida and the University of Rochester report online and in an upcoming print edition of the International Journal of Radiation Oncology, Biology, Physics.

“The dogma is that this type of disease is incurable and that if there’s a metastatic tumor in one organ, then others must be present throughout the body,” said investigator Dr. Paul Okunieff, director of the UF Shands Cancer Center and chairman of the UF College of Medicine’s department of radiation oncology. “It’s considered an all-or-none phenomenon, but the fact is this view is probably not correct. We need to think about metastasis like we think about the primary tumor: determine how much it has spread, then decide whether it’s treatable based on existing technology.”

Nearly 1.6 million Americans were diagnosed with cancer last year, and nearly 600,000 died from the disease, according to the National Cancer Institute. Experts estimate that up to 90 percent of those deaths were from metastases.

The researchers studied 121 patients who had five or fewer tumors that spread from areas such as the breast, colon or lung, to up to three additional organs. Tumors were treated with a one- to two-week radiation course strong enough to kill them and prevent their recurrence while sparing healthy tissue. In about 20 percent of the patients, who were enrolled from 2001 to 2006, long-term follow up revealed that the treated tumors did not return, nor did new ones pop up elsewhere. Very few regrowths occurred among patients who made it to three years.

Breast cancer patients fared even better, with one-third of patients being free of tumor regrowth after three years. Six years after treatment, almost half of breast cancer patients in the study were still alive — five times the survival rate for people with forms of metastatic cancer other than breast cancer. In addition, for more than one-third of breast cancer patients, the cancer did not become widespread after six years, whereas only one-eighth of people with other forms of metastatic cancer did not see their cancer spread. In general, survival was greatest among patients whose secondary tumors were relatively small and responded well to chemotherapy or hormone treatment given before radiation.

“Our results suggest that patients with metastases that are limited in number and extent should be considered for potentially curative radiotherapy, said investigator Dr. Michael Milano, an associate professor of radiation oncology at the University of Rochester. “Further studies are needed to ascertain which patients are most likely to benefit, either through prolonged survival or, perhaps, a cure. We need a better understanding of the biology of cancer, and what makes one person’s cancer behave so differently from another’s.”

Some patients in the study had recurrence of a small number of tumors, and retreatment with targeted radiation controlled their disease.

The researchers call for further investigation into the most appropriate types of treatment for cancer that has spread to limited areas, and the types of cancers most likely to respond.

“Given the promising results of precisely targeted radiation in controlling the spread of disease, easing pain and even unexpectedly extending patient survival — as we’ve seen in our own clinical experience and in the published literature — we must pursue research that advances our understanding of the mechanisms at work,” said Dr. Raymond B. Wynn, executive director for stereotactic radiosurgery at the University of Pittsburgh Medical Center Cancer Center, and a clinical professor of radiation oncology at University of Pittsburgh School of Medicine. “Fortunately, we are more than halfway there.”

[bejuce]

Wow! This is wonderful, thanks for posting!

[Ellie F]

Thanks for posting Joan. This is really very encouraging information especially the bit related to bc!

Ellie

[Bunty]

This is very interesting - thanks for posting. My onc came back from San Antonio all very gung-ho about looking into the possiblity of me having radio-frequency ablation on my liver and lung tumour. (It's not common practice in Australia for metastatic BC.) I'm having scans in two weeks and if things are stable he will refer me to an interventionist radiologist. I would be interested in anyone's experience/thoughts on this.
Cheers Marie

[Hopeful]

Joan, great article, thanks. The lead sentence, though, is certainly one of the biggest understatements of all time:

"Cancer that has spread from the site of an original tumor to other places in the body is often viewed as problematic."

Hopeful

[Joan M]

Marie, I had a lung wedge resection in 2007 and the tumor recurred a year later. I then had an RFA to ablate the recurrence and haven't had anything in the lung since then. Interventional radiologists have been doing RFAs in the liver much longer. Joan

[Joan M]

Marie, PS

It's not common practice here either. Since advanced disease is systemic most oncologists shun local treatments. But I'm still being treated systemically. With Herceptin every 3 weeks, but not with chemotherapy.

If you want to learn more about local treatments, here's a link to a video of Dr Hirose's presentation at the Metastatic Breast Cancer Network's conference in October at Johns Hopkins Hospital in Baltimore. I attended the conference and thought his presentation was excellent. But also keep in mind that Hirose is a surgeon and may feel that interventional radiologists (the docs who do RFAs) are stepping on surgeons' turf. Therefore he remarked that RFA is used for patients who cannot withstand surgery. However, that may not be true in all cases. IR docs feel that their procedure is less invasive than surgery and does as good a job under certain criteria.

http://mbcn.org/special-events/categ...sentations/P6/

Good luck with your treatments!!!

Joan

[Lauriesh]

Hi Marie,
I had RFA on my liver tumor last Feb.25. I have been NED since then and I am now on Herceptin and tykerb.

It was a very easy procedure for me. It was not done because I couldn't withstand surgery. The wonderful surgeon I met with actually encouraged me to go with the RFA first, and said I could always have resection in the furure if I needed it.

but, both the surgeon and interventional radiologist said that they would only do a liver procedure on me if I had no other mets, such as bone or lung mets.


Laurie

[Joan M]

Lauriesh, I would agree. You and I both had limited disease (until I had my brain met afterward), which the story noted is an ideal patient. When I became stage 4 I had only a single, 9 mm lung nodule that was very amenable to local treatment followed with Herceptin. Joan

[Bunty]

Thanks Joan and Laurie for your experiences. I certainly don't want to get my hopes up too much yet as there are a number of steps yet to see if I would be a candidate for RFA. First thing is to get the scans out of the way (including checking out my brain to make sure nothing has popped up there).

Thanks for the link to the video presentation too!

I'll let you all know how the scans go in a couple of weeks' time.

Cheers Marie

[Joan M]

Marie,

I had a brain nodule when the RFA was done but nobody new it at that point. And thank goodness for that! Otherwise, the IR doc wouldn't have done the procedure.

The RFA was in mid August and a second routine annual brain MRI done in October, 16 months after the first, showed a 2.6 cm brain nodule. But I had no symptoms.

You can take this message which ever way you wish, unless you have symptoms ...

Joan