Lung Metastases: Locoregional Therapy vs External Beam Radiation

The 2023 Symposium on Clinical Interventional Oncology (CIO) featured a panel discussion on lung metastases moderated by Dr. Steven Yevich from MD Anderson Cancer Center, with insights from Dr. Robert Suh of UCLA and Dr. Adeel Kaiser from the Miami Cancer Institute.

The 2023 Symposium on Clinical Interventional Oncology (CIO) featured a panel discussion on lung metastases, focusing on the comparative merits of local regional therapy and external beam radiation. Moderated by Dr. Steven Yevich from MD Anderson Cancer Center, the panel included insights from Dr. Robert Suh of UCLA and Dr. Adeel Kaiser from the Miami Cancer Institute. The discourse aimed to provide a nuanced understanding of the two therapeutic approaches and their relevance in contemporary oncology. 

Dr. Suh made a compelling case for stereotactic body radiation therapy (SBRT), underscoring its comparative effectiveness versus surgical resection, considered the gold standard for local therapy. Drawing on pertinent studies, Dr. Suh argued that SBRT significantly enhances overall survival for patients grappling with lung oligometastases. The Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastases (SABR-COMET) trial was introduced as pivotal evidence, demonstrating the substantial improvement in both overall and progression-free survival with the incorporation of SBRT. Dr. Suh also delved into the feasibility of single-fraction SBRT, citing relevant studies, and acknowledging the importance of extended follow-up data to validate its efficacy. 

Contrastingly, Dr. Adeel Kaiser advocated for thermal ablation, particularly radiofrequency ablation (RFA), positing it as a viable alternative with comparable survival rates to surgical resection. The preservation of lung function emerged as a focal point in Dr. Kaiser's argument, highlighting the capacity of thermal ablation to maintain effective local control while safeguarding pulmonary capabilities. A compelling case study featuring a patient with metastatic ampulla of Vater adenocarcinoma illustrated the success of ablation for treating nine lung metastases, resulting in the patient being off all therapies. 

Both speakers emphasized the importance of a multidisciplinary approach, considering factors such as patient response to systemic therapy and individual preferences. The customization of treatment plans based on patient characteristics and preferences was underscored as a critical aspect of achieving optimal therapeutic outcomes. Dr. Suh concluded by shedding light on ongoing research, particularly the Stereotactic MR-guided on-table Adaptive Radiation Therapy (SMART1) trial at his institution, exploring MR-guided radiation therapy for metastases, including lung, delivered in a single session. 

In the subsequent Q&A session moderated by Dr. Yevich, Dr. Kaiser addressed questions pertaining to patient selection, systemic therapy testing, and the role of interventional radiology (IR) within the multidisciplinary team. Dr. Suh responded to inquiries about emotional considerations for patients and the potential role of IR in specific cases. 

The panel discussion presented a comprehensive overview of the evolving landscape of lung metastases treatment, with a focus on patient-centered care and the collaborative integration of various specialties to optimize therapeutic outcomes.