Review of Prospective Trials Assessing the Role of Stereotactic Body Radiation Therapy for Metastasis-directed Treatment in Oligometastatic Genitourinary Cancers.

Emerging evidence supports the use of stereotactic body radiation therapy (SBRT) as metastatic-directed therapy (MDT) for oligometastatic genitourinary cancers; however, the prospective data to guide its application as an alternative standard of care remain limited.

To review prospective trials that assess the role of SBRT for patients with genitourinary cancers within a modern framework of oligometastatic disease (OMD) and to highlight clinical scenarios where SBRT may offer a benefit to patients with metastatic cancer.

We performed a critical review of PubMed and clinicaltrials.gov in April 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, combined with expert input to identify prospective studies investigating the role of SBRT for oligometastatic prostate, renal, or bladder cancer.

The most commonly studied application of SBRT has been for metachronous oligorecurrent hormone-sensitive prostate cancer (HSPC). Further prospective study is needed to define the role of SBRT in delaying time to next therapy or inducing synergy with other systemic therapies.

SBRT has been associated with high rates of local control and minimal risk of toxicity with multiple trials assessing an MDT-alone approach for oligorecurrent HSPC. From a tumor-agnostic perspective, the clinical benefit of SBRT for OMD has been associated with the ability to extend overall survival. As methods of cancer detection and treatment evolve, expansion of studies that prospectively evaluate SBRT MDT, stratifying by tumor histology and oligometastatic state, is needed to inform optimal patient selection and treatment strategy.

We review outcomes from prospective trials assessing the role of stereotactic body radiation therapy (SBRT) for oligometastatic genitourinary cancers, which have predominantly investigated SBRT for oligorecurrent prostate cancer. Much work remains to define how SBRT alone compares with other standard of care treatments for prostate cancer or the role of SBRT in tumor control or delaying time to next therapy in oligometastatic renal and bladder cancer.

European urology oncology. 2022 Oct 22 [Epub]

Mai Anh Huynh, Chad Tang, Shankar Siva, Alejandro Berlin, Raquibul Hannan, Andrew Warner, Bridget Koontz, Gert De Meeleer, David Palma, Piet Ost, Phuoc T Tran

Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. Electronic address: ., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, Melbourne, Australia., Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada., Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., London Health Sciences Centre, London, ON, Canada., GenesisCare US, Fort Myers, FL, USA., Department of Radiotherapy and Oncology, University Hospitals Leuven, Leuven, Belgium., Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium., Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: .

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