The phase 2 SAFRON II trial randomized 90 patients receiving stereotactic body radiation (SBRT) for uncomplicated lung mets <5 cm in size and >2 cm from central structures to either 48 Gy / 4 or the more ambitious 28 Gy / 1. Though some argue biological equivalent dose [BED10] theory falls apart at ablative doses, the two arms, in theory, carry the weight of a BED10 of 106 Gy. Among the 74 patients with available data, for the primary endpoint of grade 3+ toxicity occurred in only 1 patient (3%) after 48 Gy / 4 and 2 patients (5%) after 28 Gy / 1. Local control at one year was excellent as anticipated at 95% and 93%, respectively. TBL: Single-fraction SBRT for lung metastases has toxicity and local control comparable to fractionated SBRT. | Siva, ASTRO 2020


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