title: Is Stereotactic Body Radiotherapy (SBRT) in lymph node oligometastatic patients feasible and effective?
abstract: OBJECTIVE
  To review the available data about stereotactic body-radiotherapy (SBRT) for oligometastatic lymph node cancer recurrence.
  
  
  METHODS
  The inclusion criteria for this study were as follows: Medline search for the (1) English language (2) full paper (abstracts were excluded) on (3) adult oligometastatic solid cancer recurrence limited to lymph node that underwent SBRT (4) outcome data available and (5) published up to the 30th April 2014.
  
  
  RESULTS
  38 papers fulfilling the inclusion criteria have been found: 7 review articles and 31 patient series (20 and 11 retrospective and prospective studies, respectively) including between 1 and 69 patients (636 lymph nodes). Twelve articles reported only lymph node SBRT while in 19 - all types of SBRT including lymph node SBRT were presented. Two-year local control, 4-year progression free survival and overall survival was of up to 100%, 30% and 50%, respectively. The progression was mainly out-field (10-30% of patients had a recurrence in another lymph node/nodes). The toxicity was low with mainly mild acute events and single grade 3-4 late events. When compared to SBRT for any oligometastatic cancer, SBRT for lymph node recurrence carried better prognosis and showed lower toxicity.
  
  
  CONCLUSIONS
  SBRT is a feasible approach for oligometastatic lymph node recurrence, offering excellent in-field tumor control with low toxicity profile. The potential abscopal effect has been hypothesized as a basis of these findings. Future studies are warranted to identify the patients that benefit most from this treatment. The optimal combination with systemic treatment should also be defined.
authors.affiliation: Department of Radiotherapy of the European Institute of Oncology, Milan, Italy ; University of Milan, Milan, Italy.
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: Department of Radiotherapy of the European Institute of Oncology, Milan, Italy ; Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy ; University of Milan, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ronchi
authors.affiliation: Department of Radiotherapy of the European Institute of Oncology, Milan, Italy ; Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy ; University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
keywords: Lymph nodes; Oligometastatic cancer; Recurrent cancer; Stereotactic body radiotherapy