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HEALTHCARE JOURNAL OF NEW ORLEANS I  JAN / FEB 2022 57 Suchit H. Patel, MD, PhD Radiation Oncologist Terrebonne Medical Center | Mary Bird Perkins Cancer Center Furthermore, SBRT is not a risk-free treat- ment, posing significant treatment-related risks itself. Many questions also remain open. For example, having five lesions is simply an arbitrary cutoff, though reason- able. Is the data valid for three or 10 lesions? Does a patient with initially widespread dis- ease who has only a few areas left after ini- tial chemotherapy also stand to benefit from this aggressive approach? Which kinds of primary cancer are suitable for this? Is SBRT or surgical removal of the tumor preferable? These and other questions are now the target of a plethora of ongoing oligometa- static-focused studies. NRG LU002, a large national trial with a target accrual of 400 patients, is examining whether this ap- proach holds promise for lung cancer pa- tients with three or fewer metastatic lesions. SABR-COMET-3 is similar to the original SABR-COMET trial but open to all solid tu- mors. SABR-COMET-10 is open for up to 10 lesions. A recent trial, ORIOLE, reported promising findings in oligometastatic pros- tate cancer patients treated with SBRT to all sites of diseases as well. There are ongoing studies for breast, esophageal and gastric cancers, among others. All of these should help allay some of the above concerns, at least. More recently, immunotherapy — treat- ment that allows the native immune sys- tem to recognize and target cancer cells — has been incorporated into many regi- mens, particularly for metastatic cancer, with improving outcomes for this patient population. Therefore, there is now strong interest in exploring how best to combine oligometastatic-directed therapy with im- munotherapy regimens. Indeed, the ORIOLE trial showed a durable systemic immune response with SBRT, as has been found in melanoma patients treated with SBRT as well. Thus, whether SBRT can help improve the efficacy of immunotherapy remains a provocative question. While none of these trials have yet to prove that a metastatic patient has been cured, the vast majority of these data are simply too recent to have the long-term follow-up to reveal that with certainty. They certainly accord with the anecdotal experi- ences of mine and others who have treated now-long-term survivors of a so-called in- curable disease. Still, they herald an excit- ing frontier for the treatment of advanced cancer patients, further cementing the no- tion that incurable doesn’t mean untreat- able and that eventually, incurable may no longer be so. n REFERENCES 1 Hellman, S., & Weichselbaum, R. “Oligome- tastases.” DOI: 10.1200/JCO.1995.13.1.8 Journal of Clinical Oncology 13, no. 1, 8-10. Jan. 1, 1995. 2 Palma, D., et al. “Stereotactic ablative ra- diotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial.” DOI: 10.1016/S0140- 6736(18)32487-5. The Lancet 393, no. 10185, 2051-2058. May 18, 2019. 3 Palma, D., et al. “Stereotactic Ablative Radio- therapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial.” DOI: 10.1200/JCO.20.00818 Journal of Clinical Oncology 38, no. 25, 2830-2838. Sept. 1, 2020. Suchit H. Patel, MD, PhD, is a summa cum laude graduate of New York Institute of Technology. He earned a Doctor of Philosophy in Neuroscience from The Rockefeller University and a Doctor of Medicine with Honors in Service from Weill Cornell Medical College in New York, New York. He completed his radiation oncology residency training at Memorial Sloan Kettering Cancer Center in NewYork,NewYork, where he served as chief resident, was awarded the Mortimer J. Lacher Fellowship in radiation oncology and completed his postdoctoral research. He has authored a number of publications, delivered many presentations at oncology conferences and holds several active grants. Patel has been withMary Bird Perkins Cancer Center for more than two years and has been practicing at the Cancer Center’s Baton Rouge, Hammond and Gonzales locations. The majority of his practice will now be focused in Houma. “More recently, immunotherapy — treatment that allows the native immune system to recognize and target cancer cells — has been incorporated into many regimens, particularly for metastatic cancer, with improving outcomes for this patient population. Therefore, there is now strong interest in exploring how best to combine oligometastatic- directed therapy with immunotherapy regimens.”