The role of radiation therapy in metastatic cancer is rapidly evolving with increased understanding of the oligometastatic state and improved technologies to deliver higher doses of radiation with greater precision and avoidance of normal tissues than before. Recent data have demonstrated that the use of stereotactic ablative radiotherapy (SABR) in oligometastatic disease confers a survival benefit. Yet, the current enthusiasm must be balanced with caution. Here we summarize the evidence in favor of SABR for oligometastatic patients as well as the concerns regarding rapid adoption into clinical practice and outline broad principles to guide clinical trials evaluating the role of SABR in oligometastatic disease. As oncologists, we must exercise due diligence and gather the appropriate evidence necessary to 1) understand the oligometastatic disease state and 2) optimize benefit in those patients before broadly offering SABR to all. Any alternative path forward will do our field and our patients a great injustice.
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1-year efficacy results after MR-guided risk-adapted stereotactic radiotherapy of infra-diaphragmatic oligometastases in a multicenter phase II trial.
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Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev 2730 Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark.
Background And Purpose: The SOFT (Stereotactic ablative radiotherapy of infra-diaphragmatic sOFT tissue metastases) trial assesses the safety and efficacy of risk-adapted MR-guided stereotactic ablative radiotherapy (SABR) of infra-diaphragmatic soft tissue metastasis in patients with oligometastatic disease (OMD) (clinicaltrials.gov ID NCT04407897). This paper reports the one-year efficacy analysis and evaluates associations between local control (LC) and clinical and dosimetric parameters.
View Article and Find Full Text PDFCost-minimization analysis of the GORTEC 2014-04 randomized phase II study of stereotactic ablative radiotherapy (SABR) or chemotherapy-SABR in oligometastatic head and neck cancer.
Radiother Oncol
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GORTEC 4 bis rue Emile Zola 37000 Tours, France; Department of Radiotherapy, Centre François-Baclesse, Corpuscular Physics Laboratory, IN2P3, ENSICAEN, CNRS UMR 6534, Université de Normandie, Caen, France. Electronic address:
Purpose: The randomized phase II GORTEC 2014-04 and French Head and Neck Intergroup study showed deeper deterioration of the quality of life (HRQoL) and dramatically higher severe toxicity rates with similar overall survival rates using chemo-SABR compared to SABR alone in oligometastatic head and neck cancer (HNSCC) patients. We evaluated the costs associated with SABR-alone versus chemo-SABR and their associated costs (transportation, hospitalizations, etc).
Materials And Methods: 69 HNSCC patients with 1-3 oligometastases and a controlled primary were randomized from September 2015 to October 2022.
PSMA+ Extracellular Vesicles are a Biomarker for SABR in Oligorecurrent Prostate Cancer Analysis from the STOMP-like and ORIOLE trial cohorts.
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Mayo Clinic, Rochester, MN, United States.
Purpose: Two randomized clinical trials (STOMP and ORIOLE) demonstrated that stereotactic ablative radiotherapy (SABR) can prolong ADT-free survival or progression-free survival (PFS) in patients with metachronous oligometastatic prostate cancer (omCSPC) patients. While most omCSPC patients have a more modest delay in progression, a small subset achieves a durable response following SABR. We investigated the prognostic and predictive value of circulating PSMA-positive extracellular vesicles (PSMA+EV) and prostate specific antigen (PSA) in a biomarker correlative study using blood samples from three independent patient cohorts.
View Article and Find Full Text PDFMetastasis-directed therapy in oligometastatic and oligoprogressive renal cell carcinoma.
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Division of Urologic Oncology.
Purpose Of Review: This review addresses the evolving role of metastasis-directed therapy (MDT) in the management of oligometastatic and oligoprogressive renal cell carcinoma (RCC). With advances in both surgical techniques and stereotactic ablative radiotherapy (SABR), it is timely to explore how MDT can improve patient outcomes in these distinct disease states. The review highlights the potential of MDT to delay systemic therapy and improve quality of life while noting the lack of randomized clinical trial data guiding its use.
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Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada.
Purpose: To conduct an international survey of radiation oncologists treating primary renal cell carcinoma (RCC) with SABR to ascertain the general patterns of SABR use, common dose/treatment/follow-up details, and expected outcomes.
Materials And Methods: A 51-question survey was created containing the following themes: prevalence and clinical scenarios in which RCC SABR is used, dose-fractionation schedules, treatment delivery details, follow-up/outcome assessments, and implementation barriers. The survey was distributed widely across multiple influential radiation oncology societies and social media, and ran from January to April 2023.
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