Q. Is there a role for radiation therapy in the setting of metastatic cancer?
A. Radiation therapy is often thought of as being only part of cancer treatment in the upfront setting. Patients will have surgery to remove a breast tumor and then radiation therapy afterwards. Or they will have radiation therapy alone to cure their prostate cancer. However, there are many important roles for radiation therapy in patients that have had cancer spread to other parts of the body.
Sometimes a patient will have a painful deposit of cancer in a bone or lymph node. Focal radiation therapy, or palliative radiation therapy, can be used to spot treat these areas and provide relief of symptoms.
However, there is new research emerging in the realm of oligometastatic cancer. This refers to patients that are otherwise doing well, but have just one or a few sites were cancer has spread. Clinical studies are suggesting that if we aggressively treat these patients, by controlling both their primary cancer and their few metastatic sites, they may live longer and indeed even be curable – something that was generally not thought to be possible before. This is another area where radiation therapy can play a role in the metastatic setting. A type of treatment called Stereotactic Body Radiation Therapy (SBRT) can be employed to deliver a very focused, high dose of radiation to the metastatic sites, with the goal of killing all of the cancer cells in the area. SBRT treatments are generally given daily over 1 to 5 days.
Excitingly, at Hoag we have a new piece of technology that allows us to more accurately and safely give SBRT treatments. The ViewRay is a precision radiation therapy machine with an onboard MRI scanner. This allows us to image the patient and their tumor in real time. The tumor can be better visualized than with conventional radiation treatment machines and the motion of the tumor can be tracked. This allows the radiation dose to be tailored to the individuals anatomy on the day of each treatment.
Regardless of the setting, radiation therapy has many important roles for patients with metastatic cancer, helping to improve both quality and quantity of life.
