Clinical outcomes of stereotactic body radiotherapy in oligometastatic disease: a national real-world cohort study

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PURPOSE: We conducted the first multicentre Spanish real-world study assessing the efficacy and safety of stereotactic body radiotherapy (SBRT) in oligometastatic patients treated in routine clinical practice. METHODS: This retrospective, multicentre observational study included oligometastatic patients with primary solid tumours treated with SBRT between 2020 and 2024 across 12 Spanish radiotherapy centres. The primary endpoint was 1-year progression-free survival (PFS). The secondary endpoints included overall survival (OS), local control (LC), and acute and late adverse events by CTCAE v.5.0. RESULTS: 300 patients with 451 treated lesions were included. Median age was 69 years. After a median follow-up of 22 months, 1- and 2-year PFS were 45.1% and 36.3% respectively, with a median PFS of 11 months (95% CI, 9-13). The 1- and 2-year OS were 92% and 82.9% (median not reached), and 1- and 2-year LC were 90.5% and 85.5% respectively. Multivariable analyses showed significantly better PFS and OS in prostate cancer patients. Repeat and induced oligometastatic patients showed worse PFS than those with synchronous disease (HR 2.86, 95% CI 1.59-5.13; p<0.001 and HR 2.97, 95% CI 1.58-5.57; p<0.001, respectively). Visceral-only disease also correlated with worse PFS compared to bone-only metastases. Local control was poorer in lesions ≥5 cm compared to <5 cm (p<0.001). Grade ≥3 acute and late adverse events occurred in 0.7% and 1% of patients. CONCLUSION: In this real-world multicentre cohort, SBRT to the oligometastases showed efficacy with minimal adverse events. Prognostic differences among subgroups underscore the importance of an adequate patient selection and individualized treatment strategies.

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