Use of Ablative Radiotherapy in the Setting of Oligometastatic Disease

The oligometastatic paradigm, conceptualized over 3 decades ago, challenges the binary view of cancer as strictly localized or widely metastatic and suggests that some patients present with a limited number of metastatic deposits amenable to local therapy that can allow for prolonged disease-free survival or in some cases no recurrence of disease. Advances in radiation delivery, particularly stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiation therapy, have enabled the safe and effective delivery of high-dose, ablative radiation to discrete tumor sites, providing a highly attractive noninvasive local therapy option for patients with oligometastatic disease (OMD). Growing evidence supports the role of SBRT in improving progression-free survival, delaying systemic therapy change, and potentially enhancing overall survival in select patients. This review synthesizes current data on SBRT for OMD across tumor sites, discusses patient selection considerations, and explores ongoing controversies and future directions including integration with immunotherapy and novel systemic agents.