SynthesisRadiation oncology (London, England)2026
Efficacy and safety of metastasis-directed therapy for oligometastatic cancer: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Radiation oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetastasis-directed therapy (MDT) is a promising therapeutic strategy in oligometastatic cancer, but its safety and efficacy remains uncertain. This systematic review and meta-analysis aims to evaluate the efficacy and safety of MDT interventions in randomized controlled trials (RCT) of oligometastatic cancer.
methodsThis study was prospectively registered in PROSPERO (CRD420251075947). A literature search of MEDLINE, Embase, and Cochrane CENTRAL was conducted from inception to June 9, 2025. Eligible RCTs compared MDT interventions with standard of care in patients with oligometastatic cancer (≤5 lesions). Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and adverse event (AE) rates were pooled using random-effects meta-analysis.
resultsThirty seven records representing 3,500 participants were included. Subgroup analyses showed upfront MDT improved both PFS (HR = 0.45, 95% CI 0.32-0.64) and OS (HR = 0.49, 95% CI 0.38-0.64), while consolidation MDT improved PFS only (HR = 0.56, 95% CI 0.40-0.78). In de novo oligometastatic disease, MDT improved PFS (HR = 0.50, 95% CI 0.32-0.78) but not OS, while recurrent oligometastatic disease benefited in both PFS (HR = 0.57, 95% CI 0.42-0.78) and OS (HR = 0.70, 95% CI 0.52-0.93). MDT was associated with an increased odds of Grade ≥ 2 adverse events (OR = 1.77, 95% CI [1.30-2.41]).
conclusionThe addition of MDT to standard of care improves OS and PFS in oligometastatic cancer patients, with a moderate increase in adverse events. MDT is a valuable component of multimodal therapy for oligometastatic disease, warranting further study of optimal timing, patient selection, and long-term outcomes.
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