The long view.

With increasing technological advances allowing for more and more precise delivery of high-dose radiation for metastatic lesions, the question often becomes when not to use it. Here is a no-nonsense look at the cost-effectiveness data we have to date on the use of ablative radiation for oligometastatic disease. It ultimately comes down to selecting the ideal indications for use in order to see the most bang for your buck, and continued studies evaluating well-described techniques in well-described clinical scenarios are essential—particularly those describing costs over the course of an entire diagnosis. As it stands, the RO Model appears to be much more concerned with short term spending than considering, for example, how much would ultimately be saved by delaying or avoiding systemic therapy. | Kavanagh, Semin Radiat Oncol 2021