The use of local ablative therapy or metastasis-directed therapy is an emerging management paradigm in oligometastatic and oligoprogressive cancer. Recent randomized evidence has demonstrated that stereotactic ablative radiotherapy (SABR) targeting all metastatic deposits is tolerable and can improve progression-free and overall survival. While SABR is noninvasive, minimally toxic, and generally safe, rare grade 5 events have been reported. Given this and recognizing the often-uncertain prognosis of patients with metastatic disease, equipoise persists regarding the therapeutic window within which to deploy SABR for this indication. Ongoing phase III trials are aimed at validating the demonstrated safety, tolerability, and survival benefits while also refining patient selection, possibly with the aid of novel biomarkers. This narrative review of the role of SABR in oligometastatic and oligoprogressive disease summarizes recent randomized evidence and ongoing clinical trials, discusses our rationale for treatment and key management principles, and posits that SABR should be considered the preferred modality for multisite, metastasis-directed ablative therapy.

中文翻译：

---

放射线治疗低聚和少进展性疾病：基本原理，最新数据和研究问题。

局部消融疗法或转移导向疗法的使用是少转移和少进展的癌症的新兴管理范例。最近的随机证据表明，针对所有转移性沉积物的立体定向消融放疗（SABR）是可以耐受的，可以改善无进展生存期和总体生存期。尽管SABR是非侵入性的，但毒性最小，并且通常是安全的，但已报道了罕见的5级事件。考虑到这一点并认识到转移性疾病患者的预后通常不确定，关于在该窗口内部署SABR的治疗窗口的平衡仍然存在。正在进行的III期临床试验旨在验证已证实的安全性，耐受性和生存益处，同时还可能借助新型药物来完善患者选择生物标志物。这篇关于SABR在少转移和少进展疾病中作用的叙述性综述总结了最近的随机证据和正在进行的临床试验，讨论了我们的治疗原理和关键治疗原则，并认为SABR应该被视为多部位，转移导向的消融治疗的首选方式。