This article discusses a new treatment approach for metastatic prostate cancer,specifically focusing on patients with “oligometastatic” disease (limited number of metastases).

Here’s a breakdown of the key points:

Prostate Cancer in Taiwan: Prostate cancer is the third most common cancer in Taiwan, and the number of cases is rising due to an aging population and increased screening. A notable challenge is that many patients are diagnosed at the metastatic stage, making treatment more complex.
New hope from “EXTEND Trial”: Recent international research, particularly the “EXTEND trial” published in JAMA Oncology, has brought new treatment opportunities. This study explored the effectiveness of adding radiation therapy to standard treatments for metastatic prostate cancer.
“Oligometastasis” and Metastasis-Directed Therapy (MDT): The study found that for patients with “oligometastasis” (meaning cancer has spread to only a few specific sites),combining systemic drugs (like hormone therapy or chemotherapy) with radiation therapy directed at the primary prostate tumor can be beneficial. This combined approach, referred to as “Metastasis-Directed Therapy” (MDT), showed positive results in controlling the disease and delaying its progression.
Shifting Perceptions: Previously, it was thought that local treatments like radiation therapy were less effective once cancer had metastasized. However, recent studies, including the “EXTEND trial,” are challenging this notion, suggesting that targeted local treatment can still play a significant role.
Expert Opinions: Urologist Liu Ruiming and radiation oncologist Gao Yongshuo from Taoyuan Hospital participated in international discussions about the “EXTEND trial” and published a comment letter in the journal, offering their clinical insights.
Patient Support and Multidisciplinary Approach: The doctors emphasize that while a metastatic diagnosis can be distressing, medical advancements offer hope. They stress the importance of a multidisciplinary medical team’s evaluation and cooperation to develop effective treatment strategies. They also encourage patients and their families to communicate openly with their medical team and actively participate in treatment decisions.
Recognition for Taiwanese Medicine: The fact that the doctors’ commentary was recognized by an international journal highlights the recognition of Taiwan’s clinical experience and professional views. It also helps disseminate new research findings to frontline medical practitioners,benefiting more patients.
Call for Awareness: The article concludes by urging the public to increase their awareness of early screening for prostate cancer to maximize the chances of successful treatment.

What are the potential benefits of SBRT compared to customary radiotherapy for patients with metastatic cancer?

Radiotherapy Breakthrough Aids Metastatic Cancer Treatment

Advanced Radiotherapy Techniques: A New Hope for Metastatic Cancer

Metastatic cancer, cancer that has spread from its original site to other parts of the body, presents a significant challenge in oncology. Traditionally, treatment focused on systemic therapies like chemotherapy. However, recent advancements in radiotherapy, notably stereotactic body radiation therapy (SBRT) and adaptive radiotherapy, are changing the landscape of metastatic cancer treatment. These techniques offer more precise and effective ways to target tumors, even in challenging-to-reach locations.

Understanding Metastatic Cancer & Traditional Approaches

Metastasis occurs when cancer cells break away from the primary tumor and travel through the bloodstream or lymphatic system to form new tumors in distant organs. Common sites for metastasis include the lungs, liver, bones, and brain.

Historically, systemic treatments like chemotherapy, immunotherapy, and targeted therapy have been the mainstay of treatment. While effective for some, these therapies often come with significant side effects due to their impact on healthy cells. The goal was frequently enough palliation – relieving symptoms and improving quality of life – rather than cure.

SBRT: Precision Targeting for Metastatic Disease

Stereotactic Body Radiation Therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), delivers high doses of radiation to a small, well-defined tumor volume over a few treatment sessions. This precision minimizes damage to surrounding healthy tissue.

Key Benefits of SBRT:

Higher Dose Delivery: allows for larger doses of radiation to be delivered directly to the tumor.

Fewer Treatment Sessions: Typically completed in 1-5 fractions, reducing disruption to daily life.

Improved Local Control: Demonstrated effectiveness in controlling metastatic tumors in various organs.

Reduced Side effects: Compared to conventional radiotherapy, SBRT generally has fewer and less severe side effects.

Adaptive radiotherapy is a cutting-edge technique that adjusts the radiation plan based on changes in the tumor’s size, shape, and location during the course of treatment. This is crucial as tumors can shrink or change position in response to radiation.

How Adaptive Radiotherapy Works:

1. Daily Imaging: Patients undergo daily imaging (CT or MRI) to assess tumor changes.

2. Plan Adjustment: The radiation plan is adjusted based on the imaging data to ensure accurate targeting.

3. Personalized Treatment: This allows for a more personalized and effective treatment approach.

Adaptive radiotherapy is especially beneficial for tumors that are near critical organs or those that are moving with respiration. It’s becoming increasingly critically important in treating lung cancer metastasis and liver metastasis.

Radiotherapy for Specific Metastatic Sites

Brain Metastasis: SBRT and whole-brain radiotherapy remain crucial for managing brain metastases. Newer techniques like adaptive radiotherapy are improving precision and minimizing cognitive side effects.

Lung Metastasis: SBRT is a standard treatment option for isolated lung metastases,offering excellent local control rates.

Liver Metastasis: SBRT is increasingly used for liver metastases, particularly in patients who are not candidates for surgery or ablation.

Bone Metastasis: Radiotherapy can effectively relieve pain and prevent fractures in patients with bone metastases.

Lymph Node Metastasis: Targeted radiotherapy can be used to control regional lymph node involvement.

Emerging Technologies in Metastatic Cancer Radiotherapy

Several promising technologies are on the horizon:

MR-guided Radiotherapy: Allows for real-time visualization of the tumor during treatment, enabling even more precise targeting.

Proton Therapy: Uses proton beams rather of X-rays, delivering radiation with greater precision and minimizing exit dose.

FLASH Radiotherapy: Delivers ultra-high doses of radiation in a vrey short period, potentially reducing side effects. (Still in early clinical trials)

Improved Survival Rates: In select cases, particularly with oligometastatic disease, advanced radiotherapy can improve overall survival.

Enhanced Quality of Life: Effective tumor control can alleviate symptoms and improve quality of life.

Reduced Systemic Toxicity: By focusing radiation on the tumor, systemic side effects can be minimized.

Potential for Cure: In some cases of oligometastatic disease, advanced radiotherapy can offer the possibility of cure.

Discuss Treatment Options: Have a thorough discussion with your oncologist about