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Related Experiment Video

Updated: Jan 15, 2026

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
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Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

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Adverse Events After Metastases-Directed Stereotactic Radiotherapy and Biological Cancer Therapy.

Esmée L Looman1,2, Stephanie G C Kroeze1,2,3, Jana Schaule1

  • 1University Hospital Zürich, Radiation Oncology, Zürich, Switzerland.

JAMA Network Open
|January 14, 2026
PubMed
Summary

Metastases-directed stereotactic radiotherapy (SRT) combined with biological cancer therapy (BCT) showed a favorable safety profile, with severe adverse events being uncommon. Continuing BCT during SRT did not increase risks, and interrupting BCT did not worsen outcomes.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Oncology

Background:

  • Metastases-directed stereotactic radiotherapy (SRT) is increasingly used with biological cancer therapies (BCT), including immune checkpoint inhibitors (ICIs), monoclonal antibodies (mAbs), and small-molecule drugs (SMs).
  • Potential interactions and safety profiles of combined SRT and BCT are not well understood.

Purpose of the Study:

  • To prospectively investigate the incidence of severe adverse events associated with concurrent metastases-directed SRT and BCT.
  • To evaluate the impact of continuing or interrupting BCT during SRT on patient outcomes.

Main Methods:

  • An international, prospective, multicenter, noninterventional registry cohort study (TOaSTT) enrolled 433 patients undergoing SRT for metastases concurrently with BCT.
  • Data on severe (grade ≥3) acute and late adverse events, overall survival (OS), and progression-free survival (PFS) were collected and analyzed.
  • The study compared outcomes between patients who continued BCT during SRT and those who interrupted it.

Main Results:

  • Severe acute adverse events occurred in 5.3% of treatments, and severe late adverse events in 6.3% of patients.
  • Continuing BCT during SRT was not associated with an increased risk of severe acute or late adverse events.
  • Interrupting BCT during SRT was not associated with worse PFS or OS after adjusting for performance status and histologic type.

Conclusions:

  • Concurrent metastases-directed SRT and BCT demonstrate a favorable safety profile, with a low incidence of severe adverse events (<10%).
  • Continuing BCT during SRT appears safe and does not elevate the risk of adverse events.
  • Interrupting BCT during SRT does not negatively impact survival outcomes, suggesting flexibility in treatment management.