Stereotactic Ablative Radiotherapy for Oligometastatic Disease: A Tale of Emperor's New Clothes or New Standard of Care?

Radiation and immune checkpoint inhibitors in the treatment of oligometastatic non-small-cell lung cancer: a practical review of rationale, recent data, and research questions

“…It also ablates multiple targets simultaneously, achieves good rates of local control, and requires no post-surgical healing time. 4,6,[15][16][17] The objectives of treating OMD using SABR include (1) ablating all sites of visible disease to reduce tumor burden; (2) preventing progression to a polymetastatic disease state; (3) relieving morbidity associated with metastases without a decline in quality of life 18 ; (4) delaying the start of systemic therapy and its associated toxicity 19,20 ; and (5) providing cost-effective treatment. 21 There are a number of reasons to support the use of SABR in the OMD setting.…”

When Less is More: The Rising Tide of Hypofractionation

“…Macbeth and Treasure [ 11 ] and Chapman and colleagues [ 12 ] debate the role of SABR for oligometastatic disease, perhaps the single-most prominent indication that has defined the role of ultra-hypofractionated radiotherapy in a point–counterpoint argument. Whereas, Macbeth and Treasure [ 11 ] question the evidence base for SABR, attributing its popularity to ‘cognitive and technical biases’ and ‘the unconscious tendency of individuals to fit their processing of information to conclusions that suit some end or goal’, Chapman and colleagues [ 12 ] explore the biological underpinnings for oligometastatic disease and highlight six randomised controlled trials that argue the case in its favour. However, they acknowledge the need for careful patient selection and for molecular-based strategies to define suitable candidates.…”