Benjamin Movsas, MD
Benjamin Movsas, MD, who was not involved in the phase II trial of prophylactic radiation for bone metastases, commented: “I thought this was a very important study. We will need to see the details in the final paper, but this approach could make a meaningfuldifference in the quality of life for our patients. The study is hypothesis-generating, but there should quickly be a larger follow-up study. I think the findings will be confirmed, and, in my opinion, this is on the path toward becoming practice-changing.” Dr. Movsas is Chair of the Department of Radiation Oncology and Medical Director of the Henry Ford Cancer Institute in Michigan.
“The study suggests a key role for radiation even in situations where you typically might not think of it. These patients had multiple bone metastases, and that indicates a systemic problem. If the patient is asymptomatic, the current dogma is that there is usually no clear role for radiation in this setting,” Dr. Movsas continued. ”Indeed, it’s important that we don’t overtreat with radiation.”
“This study, however, focused on high-risk bony lesions based on certain risk factors, with size and location among them. The question is if we give a short course of radiation therapy now, will the patient benefit down the road, and the answer based on this study appears to beyes,” he stated.
A short course of radiation to asymptomatic bone metastasis dramatically reduced the incidence of skeletal-related events and pain, which is debilitating for patients who often require hospital admission and/or surgical intervention,” Dr. Movsas added. “The dramatic reduction in skeletal-related events would, on its own, be a reason to consider this approach from a quality-of-life perspective, preventing a debilitating event while also achieving cost savings.”
“The study was provocative because it also suggested that patients who received radiation therapy actually lived longer. This is fascinating to me,” he commented.
Number of Lesions
Dr. Movsas made an important distinction between the patient population included in the study and selected patients with oligometastatic disease, for whom radiation therapy is sometimes used as part of the treatment strategy. “Oligometastatic disease is typically defined as fewer than five metastatic lesions. More studies are emerging that indicate that early radiation to ablate oligometastatic disease can improve local control and/or progression-free survival,” he explained. “The patients in this study had at least five metastatic lesions, and at least one lesion was asymptomatic. We don’t know the details yet about how many of the lesions were symptomatic and how many were asymptomatic. That should be included in the final paper.”
“I give these authors a lot of credit. Bone metastases are unfortunately a common problem and a real issue,” Dr. Movsas continued. “They have reported on a very simple, streamlined, cost-effective way to significantly reduce a patient’s risk of developing a skeletal-related event. That alone would be clinically meaningful.”
DISCLOSURE: Dr. Movsas has received institutional research support from Varian, ViewRay, and Phillips.
