LAUSR

According to the oligometastatic paradigm, patients with a limited number of metastatic lesions can be amenable to curative treatment if all lesions are resected or ablated using stereotactic ablative radiotherapy (SABR). Most of the evidence supporting this paradigm is from observational studies, but now the results of a randomized phase II trial indicate that SABR improves overall survival (OS) in these patients. In the SABRCOMET trial, 99 patients with a controlled primary solid tumour and 1–5 metastatic lesions were randomly allocated to receive standardof-care palliative treatment alone (control; n = 33) or in addition to SABR delivered to all metastatic lesions (n = 66). Median OS was longer with SABR than with no ablative treatment: 41 months versus 28 months (HR 0.57, 95% CI 0.30–1.10; P = 0.09). “We used a randomized phase II trial screening design, and thus a P value ≤0.2 for OS indicates a positive result,” explains lead investigator David Palma. Median progressionfree survival was also longer with SABR: 12.0 months versus 6.0 months (HR 0.47, 95% CI 0.30–0.76; P = 0.0012). The percentage of patients with control of all lesions that were present at randomization was 75% for patients receiving SABR versus 49% with no ablative treatment (P = 0.001). No significant differences were observed in qualityof-life scores (measured with the FACTG tool). The incidence of grade ≥2 treatmentrelated adverse events (AEs) was higher with SABR: 29% versus 9% (P = 0.026). Of note, 3 patients in the SABR group and none in the control group died from treatmentrelated toxicities. In summary, evidence from a randomized trial now supports a survival benefit from SABR in oligometastatic disease. “We want M E TA S TA S I S