Local option: The rational use of local therapy in patients at high risk to die of metastatic progression

Abstract

On occasion, clinicians may be motivated to offer local therapy (eg, surgery, radiation, ablation) to patients withadvanced cancer in thehopeof prolonging survival (as opposed to palliating a symptom). An appropriately informed discussion of risks and benefits should push clinicians to reflecton the rationale for use of local therapy in a patientwhois farmore likely to die as a result of systemic progression. Ultimately, the justification for local therapy in advanced cancer must be based on several assumptions of what a patient's cancer will and will not do. The following is an attempt to provide the framework for patients and their care teams to collectively consider the assumptions surrounding the use of local therapy and the potential consequences of being wrong.