I was presenting on a new topic, it’s on low burden of metastasis in breast cancer. This is what we call in our jargon oligometastatic breast cancer, oligo means few sites of metastasis. There is a great interest nowadays on looking at how we can approach patients with few sites of metastasis with the belief, it’s only a belief, not proven yet, that a significant part of those patients will actually behave differently with better survival and don’t all go on to develop full-blown metastases like other patients with stage 4 disease.

So the talk was on how to approach low burden of metastasis or oligometastatic disease with local therapy, specifically with radiation therapy and more specifically using a technique called stereotactic body radiation therapy. This technique is actually quite advanced, very sophisticated, and it actually consists of delivering a focussed dose of radiation where these metastases could be – either in the bone, in the lung, in the brain and even in the liver or in the lymph nodes. So by doing that you could maximise the local therapy; besides the local therapy to the primary disease in the breast you treat the metastases, hoping that you can have a long-term control and possibly cure a proportion of those patients.

We believe there are at least 20%, maybe up to 50%, of those patients will enjoy a long-term disease free interval and about half of them will probably have a complete cure. This is at least some of the retrospective single institution studies have shown. But currently there are trials looking at those patients specifically and trying to understand whether local therapy, either by surgery or radiation, is going to add to the survival of those patients. So definitely there is a benefit for the patient by being, what we call, aggressive in local treatment for these sites of metastasis up to five. This is the definition of oligometastasis is up to five sites of metastasis that could be in one organ or in multiple organs.

Do you expect this to become standard treatment in the near future?

Actually it is gaining ground rapidly because the technology is there and the patients and the physicians are demanding it because we believe it’s going to help the patients. But it’s not scientifically proven to add to the survival of the patient so we are doing it because of pressure from the patient and referring physicians to maximise therapy for those patients but unfortunately we cannot tell the patient with certainty that what we are doing is adding to the survival.

Until we have the results of the randomised trials which are testing local therapy, the way I described it, versus just systemic therapy the old fashioned way and see the results, see if this is adding to the survival of the patient, until we have those results I don’t think it’s going to be routinely done. But, having said that, again because of the pressure from the patient and from the referring physicians and the treating physicians we are seeing more and more patients referred for these treatments with the expectation that we can control their disease and provide them with better survival.

What is your take home message?

In the presentation I closed by saying and telling my colleagues in the room that if you have a patient coming for SBRT for a few bone metastases or lung metastases go ahead and do it because it’s simple, it’s not adding any toxicity to the patient. At the same time it’s potentially helping them to have a better disease free interval and possibly survival. The only toxicity is cost, of course, but this is important to keep in mind. But again this is something that actually could be beneficial to the patient. This would be my summary of this technique or this approach.