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IMPORTANCE: After the publication of the landmark SABR-COMET trial, concerns arose regarding high-grade toxic effects of treatment with stereotactic ablative body radiotherapy (SABR) for oligometastases. OBJECTIVE: To document toxic effects of treatment with SABR in a large cohort from a population-based, provincial cancer program. DESIGN, SETTING, AND PARTICIPANTS: From November 2016 to July 2020, 381 patients across all 6 cancer centers in British Columbia were treated in this single-arm, phase 2 trial of treatment with SABR for patients with oligometastatic or oligoprogressive disease. During this period, patients were only eligible to receive treatment with SABR in these settings in trials within British Columbia; therefore, this analysis is population based, with resultant minimal selection bias compared with previously published SABR series. INTERVENTIONS: Stereotactic ablative body radiotherapy to up to 5 metastases. MAIN OUTCOMES AND MEASURES: Rate of grade 2, 3, 4, and 5 toxic effects associated with SABR. FINDINGS: Among 381 participants (122 women [32%]), the mean (SD; range) age was 68 (11.1; 30-97) years, and the median (range) follow-up was 25 (1-54) months. The most common histological findings were prostate cancer (123 [32%]), colorectal cancer (63 [17%]), breast cancer (42 [11%]), and lung cancer (33 [9%]). The number of SABR-treated sites were 1 (263 [69%]), 2 (82 [22%]), and 3 or more (36 [10%]). The most common sites of SABR were lung (188 [34%]), nonspine bone (136 [25%]), spine (85 [16%]), lymph nodes (78 [14%]), liver (29 [5%]), and adrenal (15 [3%]). Rates of grade 2, 3, 4, and 5 toxic effects associated with SABR (based on the highest-grade toxic effect per patient) were 14.2%; (95% CI, 10.7%-17.7%), 4.2% (95% CI, 2.2%-6.2%), 0%, and 0.3% (95% CI, 0%-0.8%), respectively. The cumulative incidence of grade 2 or higher toxic effects associated with SABR at year 2 by Kaplan-Meier analysis was 8%, and for grade 3 or higher, 4%. CONCLUSIONS AND RELEVANCE: This single-arm, phase 2 clinical trial found that the incidence of grade 3 or higher SABR toxic effects in this population-based study was less than 5%. Furthermore, the rates of grade 2 or higher toxic effects (18.6%) were lower than previously published for SABR-COMET (29%). These results suggest that SABR treatment for oligometastases has acceptable rates of toxic effects and potentially support further enrollment in randomized phase 3 clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02933242

Glioma is the most common type of tumor in the central nervous system (CNS). Diagnosis is through history, physical examination, radiology, histology and molecular profiles. Magnetic resonance imaging is a standard workup for all CNS tumors. Multidisciplinary team management is strongly recommended. The management of low-grade gliomas is still controversial with regards to early surgery, radiotherapy, chemotherapy, or watchful waiting watchful waiting. Patients with suspected high-grade gliomas should undergo an assessment by neurosurgeons for the consideration of maximum safe resection to achieve optimal tumor debulking, and to provide adequate tissue for histologic and molecular diagnosis. Post-operative radiotherapy and/or chemotherapy are given depending on disease grade and patient performance. Glioblastoma are mostly considered incurable. Treatment approaches in the elderly, pediatric population and recurrent gliomas are discussed with the latest updates in the literature. Treatment considerations include performance status, neurocognitive functioning, and co-morbidities. Important genetic mutations, clinical trials and guidelines are summarized in this review.

Radiotherapy for optic nerve sheath meningioma results in excellent local control and visual preservation.

After palliative radiotherapy for bone metastases from NSCLC, up to 30% of patients may derive no symptomatic benefit, and there are a lack of biological predictors for this. The purpose was to investigate whether EGFRand ALKgenetic rearrangements were associated with greater rates of pain response to palliative radiotherapy.

No abstract.