Spot Radiation

Spot irradiation is controversial. Some believe that it may slow progression, although there is no data to support that. In fact, when it's been tried for that purpose, more mets invariably eventually show up in other places. What confuses many people is that metastatic PC often follows a very slow course of progression anyway in its early stages, and it may take years before a second or third metastasis becomes visible. I'm not saying that it doesn't slow it down, just that there is no data to support that. It will take a controlled clinical trial to establish that, and there haven't been any yet. If it is in a safe place to give radiation, and doesn't preclude future treatment, it's hard to argue against it, even if it accomplishes nothing. Sometimes it is done for mets on bones that support weight in the hope that it may prevent a fracture later on down the line. It is also done as a palliative, if it is causing pain.

The sternum can be a difficult place. It does not support weight, and it is close to many vital organs, especially the heart. The heart is particularly vulnerable to late-term effects of radiation. Certainly, if you decide to do it, SBRT (CyberKnife is one brand of SBRT) is the way to go because sub-millimeter accuracy is particularly crucial there. A typical dose schedule might be 3 treatments of 10 Gy each. Some prefer a single treatment, and some prefer as many as 5 treatments, but there is no reason I know of to do it in more than 5 treatments. There have been experiments with using ablation (like HIFU or cryotherapy) instead of radiation for painful mets. That might be a particularly good idea for the sternum because it is readily accessible and avoids any radiation dose to nearby organs.

Is he being treated at Yale? I have been in contact with James Yu there, and he seems very knowledgeable.

I'm not sure of cost. I am under the impression it is part of the osprey trial, it is not scheduled yet . The RO is aswatha Naryana, and MO Dan Petrylak . We have not met with the RO yet, so gathering my guestions. I will look into James Yu, but Yale is a bit far if he has more than 1 treatment He is being treated at smilow in C T . Dr P. Is part of a Yale but see patients closer to us in NY once a week.
When I search for sternum Mets, a lot shows under breast cancer.

Gemlin-

By 2016, the same author (Ost) had updated his findings. Unfortunately, he found that within 3 years, 69% had more distant mets, and after 5 years, 85% of men who'd had SBRT treatment of solitary metastases, had recurrent metastases in different places. Did it slow it down? It's hard to conclude that, given the slow natural progression at first.

SBRT for oligometastatic recurrence

Take Mel (Compiler) as an example: Two years ago, a single LN met was discovered. 2 years later, there is still only the one met (with no treatment other than iADT). This is a typical progression pattern - very slow at first, accelerating later. Ost found that with spot treatment, the median time to detection of the next distant met was 21 months. But this is probably no different from the time without spot treatment. It's impossible to conclude that spot treatment accomplishes anything without a randomized control. And even if it does delay the detection of the next met for a couple of months, does it increase survival? Detectable mets are just the tip of the iceberg.

scan revealed I had a single met on T-10, a vertebra about a third of the way down your back...I had been on Lupron for a couple of years..I liked the treatment philosophy of "Find it and kill It"..My RO agreed. 5 fractions of SBRT also called Cyberknife. I have had no more mets and the progression of that single met has stopped..The last thing I wanted was having my spine collapse from that one met..

A lot of planning went into administering this radiation so as not to damage the spinal cord and my heart. Was it worth doing? Who knows? But so far so good....

Bone scans were 14 months apart, so that's the duration... But there is another factor...At the same time, I was put on Zytiga..So which treatment gets the credit? The systemic Zytiga or the spot radiation? Or perhaps the combination of the two approaches achieved the desired result...? Impossible to tell...

Hit it as hard as you can with everything that's available to you.....