HJNO Jan/Feb 2022

56 JAN / FEB 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY IN 1995, Samuel Hellman, MD, and Ralph Weichselbaum, MD, two radiation oncolo- gists from the University of Chicago, pro- posed that patients with so-called oligometa- static cancer, one in which only a few areas of disease outside the primary cancer are involved, “should be amenable to a curative therapeutic strategy.” 1 This remains some- what of a controversy, and the vast majority of metastatic patients are treated with pallia- tive-intent therapy, which is treatment aimed at slowing down the forthcoming, eventu- ally fatal, spread of the disease. Hellman and Wichselbaum reasoned that if the cancer is not widespread, then treatment such as sur- gery or radiation to directly eliminate all the tumors may be worthwhile. Certainly, it may not work for everyone, and how to do it is overall survival compared with patients who received the standard of care approach alone, corresponding to an absolute survival benefit of 25% at five years. Widely cited (now over 800 times), the trial has received much praise along with criti- cism. It is one of the earliest studies to test this idea in a randomized fashion, including patients with several different types of can- cers, and did not restrict the standard of care arm to any one form of therapy. Instead, it simply asked whether adding SBRT showed any benefit. The initial findings on the first report have been durable. Yet, the trial size is small, and careful analysis showed that many more patients with prostate cancer (who tend to live longer than patients with other meta- static cancers) were in the SBRT group. debatable. Still, the idea that a patient with perhaps a few metastatic lesions is not the same as one with widespread, multiorgan involvement may finally have some merit. Some 25 years after that initial hypoth- esis, the first trials of this approach are finally showing hints of promise. First reported in 2019 and updated in 2020, the SABR-COMET trial enrolled about 100 patients with vari- ous solid cancers with five or fewer meta- static lesions and randomized treatment to either standard of care (usually maintenance chemotherapy) or to standard plus a highly targeted form of radiation called stereotactic body radiation therapy (SBRT) — also known as SABR —to each of the metastatic lesions. 2,3 The updated data show that patients in the SBRT arm had a 22-month improvement in Oligometastatic Cancer — POTENTIALLY CURABLE? Unfortunately, cancer has often spread to other parts of the body by the time it is discovered. For example, about a third to a half of all lung cancers are metastatic at diagnosis, and therefore conventionally considered incurable. Likewise is the case for a quarter of all colon cancers. However, incurable does not mean untreatable, and increasingly, metastatic cancer appears to be ever more treatable.