The Great Debate.

Headline: The Sunday morning session at ASTRO 2019 got right to the heart of the debate over radiation for oligometastatic cancer.

The Debate: When it comes to using radiation for oligometastatic cancer, it’s one thing to be at MGH or UTSW. It’s quite another to be at a community center in Des Moines. On the preclinical side, there remain three important questions: Does aggressive local therapy to oligomets work to (1) eradicate all sites of visible disease? (2) interrupt its complex evolutionary process? or (3) stimulate an immune response? As we enter this new paradigm of oligometastatic labels, we don’t want any patients to miss out on the beneficial effects of consolidative radiation. But we also don’t want to harm patients with an overzealous adoption of consolidative treatment for all. In the clinic, it all comes down to dose. None? Standard palliative doses? “Palliative” SBRT doses? More aggressive “ablative” SBRT doses? These are very different approaches with very different risk levels. While almost all sites in the body can be safely treated with standard palliative doses, opting for truly ablative SBRT doses introduces a whole new level of patient risk that must be matched by its potential incremental benefit over safe standard dosing.

TBL: Standard palliative doses and “palliative” SBRT doses likely remain the most reasonable recs in most situations, but more “ablative” SBRT doses may be worth the risk when such treatment would otherwise be safe in that location (i.e. a solitary lung met). | ASTRO 2019