Selective treatment.

How do you ensure maximal efficacy of stereotactic body radiation (SBRT) for oligometastatic disease? Hint: it ain’t about physics. That’s right, the answer is patient selection. This Italian retrospective look at 358 patients treated with SBRT for oligomets aims to clarify who does best. Oligometastatic was defined here as no more than 5 “active” lesions in no more than 3 sites, meaning there could be additional lesions in additional sites if responding or stable with other therapy. What’s more, 40% received previous local treatment to metastatic sites, typically with resection or SBRT to another area. These fairly unselected Italians did pretty well all-around with only two grade ≥3 toxicities and close to two-thirds still alive at 2 years with a median survival just shy of 3 years. Those with mets to lung or nodes or without mets outside of treated sites lived even longer, while older patients and those with primary lung cancer fared worse. TBL: Broadly speaking, patients with oligomets have a long disease course, particularly when all sites are treated or when treated sites are in the lung or nodes. | Franceschini, Int J Radiat Oncol Biol Phys 2019