Pooled in the same direction.
Top Line: A common criticism of implementing ablative radiation as standard of care for oligometastatic disease is that the available data is quite the hodgepodge of single institution studies.
The Study: Enter this meta-analysis of 21 prospective studies of ablative (i.e., ≥5 Gy per fraction) radiation for oligomets in an effort to more strongly establish its safety and clinical benefit. Among the 943 patients with 1200 target lesions included, the Big Four comprised two-thirds of primary sites: prostate (23%), colorectal (17%), breast (13%), and lung (13%). Regarding safety, both acute and late grade 3+ toxicity came in at a mere <2%. At the same time, local control at one year was 95% with over half of subjects alive and free from any progression. As any oncologist knows, the trajectory and prognosis of oligometastatic disease varies tremendously along with patient and primary cancer, and this is what will ultimately dictate the clinical benefit of achieving local control. However, given the unquestionable safety of ablative radiation to most sites, the threshold for an individualized discussion should be low.
TBL: At the risk of stating the obvious, the first meta-analysis of its kind confirms contemporary ablative radiation for appropriately selected oligomets is safe and provides excellent local control with evidence of delaying systemic therapies and even prolonging life. | Lehrer, JAMA Oncol 2020