Gert De Meerleer, MD, PhD, of the Ghent University Hospital, Ghent, Belgium, speaks at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA. He describes oligometastatic prostate cancer and details the important role of the radiation oncologist in its management.
Transcript (edited for clarity)
Well, at first, for most stage one seminoma, you can perform active surveillance, and just follow the patient on a very strict base. But if you go for treatment, then there has been this historically decision making, certainly in Europe, that three year therapy should not be offered anymore because according to those colleagues, it induces much more secondary tumors than chemotherapy.
However, the radiotherapy schedules and the technology that they use to make the statement are very old and should not be extrapolated in the current setting. With modern radiotherapy for instance, with what we call arc therapy and certainly with proton therapy which is coming up, the incidence of secondary tumors will be far, far less than it’s with historically schedules.
Number two, when you look at the statistics of this famous paper that was published in GCO. It’s a non-inferior trial, which is not the same as equal. Non-inferior is stood for something totally different. And for a purest statistical viewpoint, it was not known inferior. It was so … I think that radiation oncology has been kicked out fat too early. And, that if a patient needs treatment for stage one seminoma, it should be explained in two different ways. Being carboplatin or being modern radiotherapy.
Also, to follow with those, because now we know that a dose of 20 gray is sufficient to treat these patients. While all comparisons were made with schedules of 30 gray and more. And the higher the dose you give, the more chance that you also have of developing secondary tumors. So, that’s also an extra point in favor of radiotherapy that you can give far lower doses than historically.
Secondly, or thirdly, the follow-up of those studies with carboplatin are very, very limited. So, the real results are the long-term we don’t know yet. I’m not saying that you cannot go for carboplatin, it’s fair to do so. But you cannot kick out radiation oncology, because of historical data. This is scientifically not fair, and therefore we publish this paper with the whole group of American and European radiation oncologists and urologists, who are into the research of urologic tumors to give away [inaudible] to the community. I think this is the main message.