Local Consolidative Therapy at Stage IV

[Gingy22]

Hi All,

I'm interested in learning more about Local Consolidative Therapy in stage IV. From what I understand, LCT is more often used in lesser stages but can be an option in IV, particularly with oligometastatic cancer (fewer than five mets).

My Mom has a met to her adrenal gland and two lymph nodes. Her oncologist said due to size and spread, she would consider LCT only if she shows a good response to her systemic treatment (she started in July). My guess is she would like to see much smaller tumors before they try to fry them. 

Can anyone share their experience with LCT/surgery/SBRT after being diagnosed stage IV or III?

I know IV is considered incurable, all the same I want to fry the suckers and be as aggressive as we can while my mom is starting out and still in relatively good health. Is this a reasonable line of thought?

[edivebuddy]

LCT is actually only stage IV.  Besides not having more than 5 metastatic sites in 3 or less organs, be She has to respond well to systemic treatments first. Then still be in good shape.

Surgery can be an option but I've usually seen radiation.

[Gingy22]

@edivebuddy Thanks for clarification on LCT. I have ups and downs, but I’m mostly staying hopeful that her scans will show a good response right off the bat. Any path to stable or NED works for me- I guess I just mentally like the idea of physically killing or removing cancer!

[Gingy22]

I found this article particularly exciting about positive outcomes with LCT:

https://www.jtcvs.org/article/S0022-5223(23)00874-7/fulltext

[Karen_L]

There is something very satisfying about the thought of those stupid tumors being reduced to ask. I've had targeted radiation to lumph nodes, lung tumor, and brain met. I wish surgery had been an option, but 🤷‍♀️, what're ya gonna do? 

Hang in. I like the article-- good for you for sticking to peer-reviewed research

[RJN]

Very late response from here, but just chipping in, in case it is still helpful. I have the exact same mets. My medical team at a UK research hospital are doing a tonne of research on treatment of oligometastatic cancer, and my protocol has largely followed this (see my signature for a full history). Basically, they believe and are attempting to document that the combination of systemic treatment (in my case immunotherapy) and control mets with RT/SBRT/surgery is the way to go. There are a LOT of evidence that oligometastatic cancer can be treated as curative cases, although some doubt if brain mets are involved. This doesn’t mean we are considered cured, but basically they will knock out any recurrence that comes along in a similar vein to treatment of stage 1/2. It is also becoming increasingly common to use RT alongside immunotherapy and chemo, although it still hasn’t been adopted as a recommendation by NICE (similar to the FDA).