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Stereotactic Radiation TherapyOligo Metastatic Disease
Ana Botero, MDRadiation Oncology Department
Memorial Cancer Institute
Oligo Metastatic Disease (OMD)
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
“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”.
5 yearsBishop AJ, Cancer. 2015
Weischelbaum, R and Hellman, S. Oligometastatic revised. Nat Rev.Clin.Oncol. 2011
Clinical Trials.gov. NCT03137771
PI: David Palma. Clinical Trials. Gov 01446744
PI: Piet Ost. Clinical Trials. Gov NCT01558427
Ost et al. J Clin Oncol 2017
PI: A. Sahgai. Canadian Clinical Trials Group
CI: Fiona McDonald
Brain Mets in Targeted Treatment Era
Khalifa, JTO 2016
EGFR(+) and Brain Mets
Take home points
Magnuson. JCO 2017
ALK(+) and Brain Mets
ALK(+) and Brain Mets
New Agents and SABR/SRS
Stephans, Red Journal 2018
New Agents and SABR/SRS
RPA – Oligometastatic NSCLC
Nomograms for Lung Mets
Limited Number of Brain Metastases
Multiple Brain Metastases
Multiple Brain MetastasesGammaKnife
Multiple Brain Metastases47 yo male, lung mets
GammaKnife, 18 Gy min dose
Tumor Progression vs. Radiation Necrosis
What about SABR and IO?
• Safety?• Timing?• Side effects• Results?
SABR and IO new standard of care?
• 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!
Thank you!
Biology and Radiation TherapyBest of ASTRO 2017
Strategies to combined ICI and RT
OMD ASTRO Refresher