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How to Safely Deliver Stereotactic Ablative Radiotherapy With High-Dose or Multi-agent Systemic Therapy.

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Stereotactic ablative radiotherapy (SABR) given during systemic therapy breaks is safe and effective for stage IV cancer patients. This approach allows continuous treatment, improving survival outcomes for oligometastatic and oligoprogressive disease.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Systemic therapy is the primary treatment for stage IV cancer, but local ablative treatments like stereotactic ablative radiotherapy (SABR) can enhance survival.
  • SABR offers the unique advantage of administration without interrupting systemic therapy.

Purpose of the Study:

  • To evaluate the efficacy and safety of SABR when administered concurrently with high-dose, multi-agent systemic therapy during the off-week of treatment cycles.
  • To assess the feasibility of integrating SABR into treatment plans for patients with advanced cancer receiving robust systemic therapies.

Main Methods:

  • A retrospective review was conducted on patients treated between 2023 and 2025 with concurrent SABR during systemic therapy off-weeks.
  • Radiation-induced side effects were analyzed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Main Results:

  • Six patients with 12 lesions were treated with various systemic agents (e.g., carboplatin, paclitaxel, pembrolizumab, fluorouracil, panitumumab, capecitabine, FOLFIRI, FOLFIRINOX).
  • The most common SABR target was the lung (45 Gy in 3 fractions), with a median planning target volume of 10cc. Median follow-up was 7.3 months.
  • No grade 3 or higher toxicities were reported; only grade 1 side effects (pain, mild diarrhea) occurred. Median overall survival was 18.9 months, with 3 distant and 1 local/regional failure.

Conclusions:

  • Concurrent SABR during the off-week of high-dose, multi-agent systemic therapy is a safe and effective treatment strategy.
  • This integrated approach enables continuous systemic therapy, making SABR a potentially preferred local ablative option for oligometastatic and oligoprogressive cancers.