• KroezeStephanie G CSGCDepartment of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland; Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland., Matea Pavic, Karin Stellamans, Yolande Lievens, Carlotta Becherini, Marta Scorsetti, Filippo Alongi, Umberto Ricardi, Barbara Alicja Jereczek-Fossa, Paulien Westhoff, Jasna But-Hadzic, Joachim Widder, Xavier Geets, Samuel Bral, Maarten Lambrecht, Charlotte Billiet, Igor Sirak, Sara Ramella, Ivaldi Giovanni Battista, Sergi Benavente, Almudena Zapatero, Fabiola Romero, Thomas Zilli, Kaouthar Khanfir, Hossein Hemmatazad, Berardino de Bari, Desiree N Klass, Shaukat Adnan, Heike Peulen, Juan Salinas Ramos, Michiel Strijbos, Sanjay Popat, Piet Ost, and Matthias Guckenberger.
• Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland; Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland.
• Lancet Oncol. 2023 Mar 1; 24 (3): e121e132e121-e132.

AbstractStereotactic body radiotherapy (SBRT) for patients with metastatic cancer, especially when characterised by a low tumour burden (ie, oligometastatic disease), receiving targeted therapy or immunotherapy has become a frequently practised and guideline-supported treatment strategy. Despite the increasing use in routine clinical practice, there is little information on the safety of combining SBRT with modern targeted therapy or immunotherapy and a paucity of high-level evidence to guide clinical management. A systematic literature review was performed to identify the toxicity profiles of combined metastases-directed SBRT and targeted therapy or immunotherapy. These results served as the basis for an international Delphi consensus process among 28 interdisciplinary experts who are members of the European Society for Radiotherapy and Oncology (ESTRO) and European Organisation for Research and Treatment of Cancer (EORTC) OligoCare consortium. Consensus was sought about risk mitigation strategies of metastases-directed SBRT combined with targeted therapy or immunotherapy; a potential need for and length of interruption to targeted therapy or immunotherapy around SBRT delivery; and potential adaptations of radiation dose and fractionation. Results of this systematic review and consensus process compile the best available evidence for safe combination of metastases-directed SBRT and targeted therapy or immunotherapy for patients with metastatic or oligometastatic cancer and aim to guide today's clinical practice and the design of future clinical trials.Copyright © 2023 Elsevier Ltd. All rights reserved.

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