Nodes? No problem.

How aggressive should we be in treating nodal involvement in the setting of oligometastatic disease? Here’s a large Italian retrospective review of 327 SBRT courses for nodal disease, most commonly treated to 7.5 Gy x 6 = 45 Gy (tumor BED of 78.75 Gy). Local control was similar to previous reports of ablative radiation to other sites of oligometastatic disease: 87% at 1 year and 77% at 2 years. Median time to treatment intensification was 15 months. Also in line with previous series, those with oligometastatic prostate cancer did even better. Notably, delivering a BED ≥75 Gy was associated with half the risk of local progression. Finally, failure in the same nodal region may not be as common as you’d think: median time to regional nodal progression was nearly 4 years, more likely to occur in those requiring upfront treatment to more than a single node. TBL: Gross nodal disease should probably receive treatment in line with other sites of oligometastatic disease. | Franzese, Radiother Oncol 2020

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