ReviewRadiation oncology (London, England)2026
Risk-adapted SBRT ([Formula: see text]) for recurrent lung-only metastases in patients with frailty or ultracentral anatomy.
Review 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
purposeStereotactic body radiation therapy (SBRT) is widely used for pulmonary oligometastatic disease. Guideline-based regimens target a biologically effective dose [Formula: see text]; However, this threshold may not be achievable in patients with limited physiological reserve or ultracentral lesions. We examined outcomes after SBRT with [Formula: see text] versus [Formula: see text] in a consecutive cohort of patients with recurrent lung-only metastases. METHODS AND MATERIALS: Consecutive patients treated with SBRT for recurrent lung-only metastases between January 2019 and December 2022 were retrospectively reviewed. Primary endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local-regional progression (FFLP). Kaplan-Meier estimates were compared using log-rank tests, and univariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). A propensity-score inverse probability of treatment weighting (IPTW) analysis adjusted for age, Eastern Cooperative Oncology Group (ECOG) performance status, Charlson Comorbidity Index (CCI), lung primary status, and number of metastases.
resultsFifty-three patients were included. Median OS was 47.3 months for [Formula: see text] versus 34.3 months for [Formula: see text] (HR 1.45; 95% CI 0.66-3.16; [Formula: see text]). Median PFS was 22.8 months versus 14.7 months (HR 1.59; 95% CI 0.82-3.11; [Formula: see text]). For FFLP, the HR was 2.67 (95% CI 0.60-11.93; [Formula: see text]). In IPTW-weighted models, [Formula: see text] was not significantly associated with OS (HR 0.58; 95% CI 0.25-1.32; [Formula: see text]) or PFS (HR 0.59; 95% CI 0.24-1.40; [Formula: see text]).
conclusionIn this retrospective cohort, [Formula: see text] was delivered to selected higher-risk patients on the basis of frailty, ultracentral anatomy, or both. Differences in OS, PFS, and FFLP compared with [Formula: see text] did not reach statistical significance, and IPTW-weighted estimates were directionally consistent. These observations are consistent with the feasibility of sub-ablative SBRT in selected higher-risk patients when ablative dosing is not safely deliverable, and they define the patient population and dose parameters that warrant prospective, risk-stratified evaluation.
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