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SABR-5 has demonstrated excellent local control when ablative radiation is delivered for oligometastatic cancer in a regional health system. Today we bring you detailed toxicity reporting. At 2 years the cumulative incidence of grade 2+ toxicity was 8% and of grade 3+ was 4%. As suggested at initial reporting, higher rates of toxicity were seen at liver and adrenal targets. In fact, the one grade 5 toxicity following 54 Gy in 3 fractions to the liver with a 125% hotspot on the right hepatobiliary tract resulting in biliary stenosis 15 months later and subsequent death from ascending cholangitis. Nonetheless, this only further supports the use of this low burden low toxicity treatment to limit systemic therapy and even prolong survival for oligomets. | Olson, JAMA Oncol 2022