Bad actors.

A few weeks back, we learned that distant metastasis velocity (DMV) can be used to identify patients at risk of widespread metastatic progression after stereotactic body radiation (SBRT) for oligometastatic disease. In this secondary analysis of the SABR-5 trial, 16% of patients had early polymetastatic recurrence (PMR)--defined as widespread disease recurrence within 6 months of initial SABR that was not amenable to further local treatment. In other words, this group likely derived little to no benefit from initial SABR. Factors associated with early PMR were lower performance status (ECOG 1-2), non-prostate/breast histology, and oligoprogressive disease. The authors used these factors to categorize patients into risk groups based on the total number of risk factors. For those with 0, 1, 2, and all 3 risk factors, median PMR-free survival was not reached, 40 months, 18 months, and 5 months. Likewise, 3-year overall survival was 93%, 77%, 53%, and 0%. | Baker, Int J Radiat Oncol Biol Phys 2022