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This Article Full Text CME: Take the course for this article: Local Surgical, Ablative, and Radiation Treatment of Metastases FREE NURSING CONTACT HOURS All Versions of this Article: caac.20013v1 59/3/145    most recent Submit a letter to the editor View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Timmerman, R. D. Articles by Lu, D. Search for Related Content PubMed PubMed Citation Articles by Timmerman, R. D. Articles by Lu, D.

Local surgical, ablative, and radiation treatment of metastases

¹Professor of Radiation Oncology, Professor of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX
²Attending Surgeon, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY
³Director and Attending Surgeon, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY
⁴Vice Chair, Technology Development, Chief, Gastric and Mixed Tumor Service, Murray F. Brennan Chair in Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
Professor, Brown Medical School, Director of Ultrasound, Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI
Associate Professor, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
Professor, Department of Radiology, Director, Hepatic Tumor Ablation Program, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA

Corresponding author: Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX 75390-9183; e-mail: robert.timmerman{at}utsouthwestern.edu

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DISCLOSURES: Dr. Timmerman has conducted contracted research for Varian Medical and Elekta Oncology. Dr. Fong has received consulting fees from Covidien. Dr. Dupuy serves as a consultant to Veran Medical, Ethicon Endo-Surgery, and Covidien, and has received grant support from Endocare, AngioDynamics, BioTex, and PneumRx. Dr. Dawson has conducted contracted research for Elekta and Bayer. Dr. Lu has served as a speaker and consultant for Covidien and Bayer HealthCare and has received a research/education grant from Endocare. No other potential conflict of interest relevant to this article was reported.

Because local therapies directed toward a specific tumor mass are known to be effective for treating early-stage cancers, it should be no surprise that there has been considerable historical experience using local therapies for metastatic disease. In more recent years, increasing interest in the use of local therapy for metastases likely has arisen from improvements in systemic therapy. In the absence of effective systemic therapies, such local treatments were often considered futile given both the difficulty in eliminating all sites of identifiable metastatic disease as well as realities regarding the rapid natural history of uncontrolled tumor dissemination. However, with a higher likelihood of patients surviving longer after effective systemic therapy, even if not cured, the goal of the eradication of residual metastases via potent local therapies can be rationalized. However, this rationalization should be evidence-based so as to avoid harming patients for no established benefit. Although surgical metastectomy remains the most common and first-line standard among local therapies, nonsurgical alternatives, including thermal ablation and stereotactic body radiotherapy, have become increasingly popular because they are generally less invasive than surgery and have demonstrated considerable promise in eradicating macroscopic tumor. Rather than eliminating the need for local therapies, improvements in systemic therapies appear to be increasing the prudent utilization of modern local therapies in patients presenting with more advanced cancer. CA Cancer J Clin 2009. © 2009 American Cancer Society, Inc.

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