Stereotactic Radiation Therapy Oligo Metastatic Disease...Oligo Metastatic Disease (OMD) Impressive...
Transcript of Stereotactic Radiation Therapy Oligo Metastatic Disease...Oligo Metastatic Disease (OMD) Impressive...
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Stereotactic Radiation TherapyOligo Metastatic Disease
Ana Botero, MDRadiation Oncology Department
Memorial Cancer Institute
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Oligo Metastatic Disease (OMD)
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Impressive Advancements in Radiation Therapy in the Last 70 years
1950’s
Cobalt machine
1960’s 1970’s 1980’s
TeletherapyLinear
Accelerators2D-
CT scan3D-CRT
Increase local control and decrease side effects
IMRTRapidArcIGRT
1990’s
SBRT
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“An attractive consequence of the presence of a clinical significant oligometastatic disease state is that some patients so affected should be amenable to a curative therapeutic strategy”.
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5 yearsBishop AJ, Cancer. 2015
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Weischelbaum, R and Hellman, S. Oligometastatic revised. Nat Rev.Clin.Oncol. 2011
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Clinical Trials.gov. NCT03137771
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PI: David Palma. Clinical Trials. Gov 01446744
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PI: Piet Ost. Clinical Trials. Gov NCT01558427
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Ost et al. J Clin Oncol 2017
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PI: A. Sahgai. Canadian Clinical Trials Group
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CI: Fiona McDonald
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Brain Mets in Targeted Treatment Era
Khalifa, JTO 2016
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EGFR(+) and Brain Mets
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Take home points
Magnuson. JCO 2017
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ALK(+) and Brain Mets
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ALK(+) and Brain Mets
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New Agents and SABR/SRS
Stephans, Red Journal 2018
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New Agents and SABR/SRS
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RPA – Oligometastatic NSCLC
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Nomograms for Lung Mets
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Limited Number of Brain Metastases
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Multiple Brain Metastases
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Multiple Brain MetastasesGammaKnife
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Multiple Brain Metastases47 yo male, lung mets
GammaKnife, 18 Gy min dose
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Tumor Progression vs. Radiation Necrosis
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What about SABR and IO?
• Safety?• Timing?• Side effects• Results?
SABR and IO new standard of care?
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• A new paradigm has recently emerged where patient treatment must be tailored to the particular case
• “One size fits all” approach is no longer appropriate in patients with stage IV cancer patients!
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Thank you!
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Biology and Radiation TherapyBest of ASTRO 2017
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Strategies to combined ICI and RT
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OMD ASTRO Refresher