Stereotactic ablative radiotherapy for oligometastatic disease
Treating every visible metastasis with ablative doses when there are only a few, on the idea that some patients with limited spread can still be controlled or cured.
Overview
The oligometastatic hypothesis, proposed in 1995, holds that some cancers spread to a handful of sites before becoming widespread, and that ablating those sites can change the course of the disease. The SABR-COMET randomised phase 2 trial reported in 2019 that stereotactic treatment of one to five metastases lengthened survival compared with standard care, with some added toxicity. Phase 3 trials (SABR-COMET-3 and -10, NRG-BR002 in breast cancer, and prostate-specific studies) are now testing the approach cancer by cancer, and it has become common practice in prostate, lung and kidney cancer with limited spread.
How it works
Ablative doses to every detectable metastasis, combined with systemic therapy, aim to eliminate the visible disease rather than merely palliate it.
- Non-invasive ablation of multiple sites
- Can delay the next line of systemic therapy
- Survival signal in randomised phase 2
- Phase 3 evidence still partial and cancer specific
- Depends on sensitive staging (PSMA PET)
- Toxicity when targets are near critical organs
Latest papers
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