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Stereotactic Body Radiotherapy Without Systemic Therapy for Oligometastatic Cancer: A Systematic Review and

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Metastasis-directed stereotactic body radiotherapy (SBRT) alone offers a viable alternative to systemic therapy for oligometastatic cancer, achieving high systemic therapy-free survival (STFS) rates, especially for renal cell and prostate cancers, with minimal severe adverse events.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Oligometastatic cancer presents a challenge for treatment selection, balancing efficacy with potential toxicity of systemic therapies.
  • Metastasis-directed stereotactic body radiotherapy (SBRT) is emerging as a strategy to delay systemic treatment in select patients.
  • Comprehensive evidence assessment for SBRT's role in deferring systemic therapy is needed.

Purpose of the Study:

  • To evaluate systemic therapy-free survival (STFS) after SBRT alone in various oligometastatic cancers.
  • To quantify adverse events, quality of life, and overall oncological outcomes following metastasis-directed SBRT.
  • To determine the efficacy of SBRT as an alternative to upfront systemic therapy.

Main Methods:

  • Systematic literature search of PubMed and EMBASE for studies published after 2009.
  • Inclusion of retrospective or prospective studies with ≥10 patients receiving metastasis-directed SBRT for oligometastatic cancer (≤5 metastases).
  • Meta-analysis of STFS rates at 1 or 2 years using a random-effects model, adhering to PRISMA guidelines.

Main Results:

  • The meta-analysis included 13 studies (984 patients), with a pooled 1- or 2-year STFS rate of 69.7% across cancer types.
  • Renal cell cancer (87.0%) and prostate cancer (78.1%) showed the highest STFS rates.
  • Severe adverse events (grade ≥3) were infrequent, reported in 1.9%-8.8% of patients in studies that observed them; 79% of studies reported no grade ≥3 adverse events.

Conclusions:

  • Metastasis-directed SBRT alone is associated with significant STFS, particularly in oligometastatic renal cell and prostate cancers.
  • The risk of severe treatment-related adverse events following SBRT is low.
  • SBRT alone may represent an acceptable alternative to immediate systemic therapy for carefully selected patients with oligometastatic cancer.