title: Pulmonary oligometastases: metastasectomy or stereotactic ablative radiotherapy?
abstract: OBJECTIVE
  Stereotactic ablative radiotherapy (SABR; or stereotactic body radiotherapy, SBRT) emerges as treatment option for pulmonary oligometastatic disease (OMD), but there are no studies comparing SABR with pulmonary metastasectomy (PME). We analysed consecutive patients referred via a university-hospital based multidisciplinary team.
  
  
  METHODS
  Patients were offered PME as first choice and SABR in case they were considered to be less suitable surgical candidates. Overall survival was the primary endpoint. Secondary endpoints were progression-free-survival, local control of treated metastases, and freedom-from-failure of a local-only treatment strategy without systemic therapy.
  
  
  RESULTS
  From 2007 until 2010, 110 patients were treated and analysed (PME, n=68; SABR, n=42). Median follow-up time was 43 months (minimally, 25). Estimated overall survival rates at one, three, and five years were 87%, 62%, and 41% for PME, and 98%, 60%, and 49% for SABR, respectively (logrank-test, p=0.43). Local control at two years was 94% for SABR and 90% for PME. Progression-free survival was 17% at three years, but 43% of the patients still had not failed a local-only treatment strategy.
  
  
  CONCLUSIONS
  Although SABR was second choice after PME, survival after PME was not better than after SABR. Prospective comparative studies are clearly required to define the role of both, SABR and PME in OMD.
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands. j.widder@umcg.nl
authors.forename: Joachim
authors.initials: J
authors.lastname: Widder
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Klinkenberg
authors.forename: Jan F
authors.initials: JF
authors.lastname: Ubbels
authors.forename: Erwin M
authors.initials: EM
authors.lastname: Wiegman
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D015996:Survival Rate
keywords: Oligometastatic disease; Pulmonary metastasectomy; Pulmonary oligometastases; Stereotactic ablative radiotherapy; Stereotactic body radiotherapy; Thoracic oncology