A recent study supports the use of radiation therapy as an alternative to surgery in late stage cancer patients.
Published Jun 10, 2022
Radiation has been shown to produce long-term survival for people with late stage cancer who are not good candidates for surgery. Those are the findings of an important piece of new research looking at metastatic cancer arising from so-called solid tumors in organs such as the lungs, breasts, and prostate. Radiation therapy consists of using radiation at relatively high doses to kill cancer specific cells and inevitably shrink tumors. Furthermore, this therapy type achieves this by attacking and damaging the DNA of cancer cells, which is its genetic makeup. Damaging these cell’s DNA beyond repair halts cancer cells from multiplying and inevitably causes them to die.
Patients with metastatic cancer, or stage four cancer, are notoriously difficult to treat. In solid tumor cancers, past research has shown that surgical removal of solid tumors combined with subsequent chemotherapy can produce long term survival for patients with late stage disease. While radiation has been notoriously used in the form of palliative radiotherapy to extend life slightly and relieve symptoms of late stage cancer, it has not been widely used to improve long term survival rate with similar success to invasive surgery. That is, until now.
“Could we offer patients a non-invasive approach that could result in long term survival like we have seen with a traditional surgical approach?” was the question posed by the study’s lead author Dr. Dwight E. Heron, director of radiation services at UPMC Hillman Cancer Center in Pittsburgh. Dr. Heron and his colleagues found that the answer appears to be a simple one, ‘yes’. Additionally, Heron hopes this study will lead to more doctors, specialists, and patients discussing radiation therapy among many treatment options when discussing late stage cancer treatment with the primary goal of increasing survival rate – not only in the context of palliative care or Quality of Life treatment as it has been notoriously utilized for up to today.
The study showed that late stage cancer patients who received high-dose radiation had significant long term survival. Specifically, the study examined 147 patients with what is called oligometastatic cancer — cancers that had been previously treated but then returned to a small number of other sites in the body. Researchers used a form of radiation therapy known as stereotactic ablative radiation (SABR) therapy. SABR therapy is considered high-dose radiation delivered in a highly precise manner targeting solid tumors. The study showed that nearly 50% of the patients given SABR therapy were alive after five years and, in a smaller subset of patients, the cancer was completely eradicated. “It is not going to cure everyone, but it can actually improve how long you live without cancer and, in a smaller group of patients, it can cure your cancer,” says Dr. Heron.
Typically, low-dose radiation has been used to alleviate symptoms in stage four cancer patients, but not necessarily to extend survival. However, this study shows the potential for high-dose radiation therapy, such as SABR, to improve outcomes. “What we have defined here is a new treatment paradigm. We’ve shown in this study [radiation] can be even more beneficial,” says Heron.
Dr. Heron believes it is important that patients with advanced stage cancer begin asking their physicians about the potential for radiation therapy in treating their disease. “If I were a patient today with stage four cancer, I would be asking my oncologist now, ‘Is there a role for SABR to help improve my chances of having a better outcome?’”
Other radiation oncologists believe that radiation therapy needs to be part of the treatment discussion for late stage patients. Dr. Daniel Gomez, a radiation oncologist at MD Anderson Cancer Center in Houston, has performed research that also supports the use of concentrated high-dose radiation therapy in late stage lung cancer patients. Gomez’s study looked at patients with oligometastatic lung cancer of the lung who received prior therapy, but whose cancer returned to a small number of sites of the body. This is the same kind of stage four, metastatic disease that Heron examined. He found a similar result to Heron: patients who received high-dose radiation lived longer than those who did not.
Dr. Gomez told SurvivorNet that Heron’s study is important in that it “not only shows the potential for high-dose radiation therapy across tumor types, but also examines quality of life.” Notably, the radiation therapy used in Heron’s study caused no negative changes in the quality of life for patients. Quality of life (QoL) is an essential element to take into account when considering a treatment plan, regardless of cancer type or stage. With survival being the ultimate goal, maintaining a positive and enjoyable lifestyle while trying to achieve this goal is something that should always be a top priority. It is important for all patients to live a pleasant, fulfilled, and meaningful life regardless of where they are in their cancer treatment journey.
Options for treatment for early and late stage cancer patients have increased in the past 15 years. Studies like Gomez’s and Heron’s show the potential for the use of radiation therapy. As Dr. Gomez puts it, “Given the long experience with surgery and with both methods being incorporated into clinical trials like this one, we will learn a great deal about the two approaches in this context over the next several years.”
Nonetheless, Gomez agrees that patients with advanced stage cancer should ask their physicians about radiation therapy, and that ultimately the decision is a personalized one. Patients facing bone metastases, brain metastases or other metastases should seriously consider consulting their physician and ask them if SABR is right for their treatment plan. Gomez explains, “I think in the setting of metastatic disease it’s a reasonable question to ask your physician, particularly about clinical trials that may be available. It’s individualized–There are certain scenarios where either surgery or radiation is a capable approach, and that choice of treatment depends on how the discussions go between the surgeon, radiologist, and patient.”
Dr. Heron suggests that the way to make sure radiation is part of the discussion is to have decisions about treatment made by doctors from different specialties. “In my view, the best model of care is a multidisciplinary, team-based approach to care.” In the past, which type of treatment you received largely depended on which type of oncologist you saw first. Now, however, Dr. Heron advises that patients consult with a team of oncologists, consisting of a surgical oncologist, a radiation oncologist, and a medical oncologist, to determine which treatment is the best course of action.
“Our patients are far more empowered as well as educated now than they have been in the past. So, they should insist that their doctors start talking to each other and ensure that they will not be denied opportunities for therapies that would benefit them.” While determining which treatment course to pursue is a complex decision, it is best made when patients are as well informed as possible with an open line of communication with their oncology specialists. Utilizing a team approach opens the door to numerous treatment avenues, which may have been shut previously if care was based solely on one clinician’s specialty. Forming a treatment partnership encompassing the patient themselves with a group of clinicians ensures all aspects are considered. Doing so helps the patient on the right track toward conquering cancer and ultimately survival.
What should patients with advanced stage cancer expect from radiation therapy going forward? Combining concentrated radiotherapy, such as SABR, with immunotherapy. Dr. Heron explains, “We think that radiation therapy can enhance the body’s immune response to cancer.” In a new clinical trial, Heron and his research group will be examining the effects of SABR on patients with a larger number of metastases–up to ten–as well as its impact on the immune system. For example, in a patient with ten metastases, Heron and his team will use radiotherapy to treat five of them and then see if the immune system can do the rest of the work. In this scenario, Heron explains, “We will take a look and see how well the radiation affects the tumors that were treated but more importantly, how it primes the immune system to respond and destroy the other five tumors that were not treated.”
Cancer is a complex condition that requires an individualized treatment action plan. Setting this individualized treatment regimen is best when it combines patient desires and expert advice from expert health care professionals and oncologists. Input regarding treatment and therapies from the patient is as valuable as the recommendations from the oncology team. Typically, later stage cancer is harder to conquer than when caught in its early stages. However, do not lose hope as certain therapies, like radiation as well as surgery, have been shown to increase one’s quality of life (QoL) as well as survival rate and life expectancy. It is easy to forget that overcoming your diagnosis is not a one size fits all model. It is important to remain open-minded and educated on all possible therapy avenues. Doing so will put you in the driver’s seat toward positive and favorable outcomes.
To learn more about the role of radiation therapy and surgery in treating solid tumors, visit some of SurvivorNet’s other resources.
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