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Can SABR Help Avoid Systemic Therapy in Oligometastatic Squamous Cell Carcinoma of the Head and Neck?
The standard approach for metastatic squamous cell carcinoma of the head and neck (SCCHN) has been systemic chemotherapy, although it is associated with significant toxicity and quality-of-life (QoL) deterioration. For patients with oligometastatic disease — an intermediate clinical state between locoregional and widely metastatic cancer — targeted therapies such as stereotactic ablative radiation therapy (SABR) may provide prolonged survival with more-acceptable toxicity. In this phase 2 trial (NCT03070366), 69 patients with SCCHN and one to three oligometastases were randomized to either SABR alone or with chemotherapy (5-fluorouracil, platinum, cetuximab).
The primary endpoint — 1-year overall survival (OS) without QoL deterioration — was similar between the two groups (55.2% and 53.3%). However, patients receiving SABR alone experienced markedly less-severe QoL deterioration and substantially lower rates of grade 3 to 4 adverse events (8.8%, compared with 60.0% with chemo-SABR). Median progression-free survival was numerically shorter with SABR alone (7.4 months) than with chemo-SABR (12.9 months), but OS was similar (41.1 and 42.3 months).
The SABR-alone arm had a slightly higher chance of developing both new metastases and local progression (16.7%) than did the chemo-SABR arm (3.7%), although rate of progression with new metastases only was similar in both arms (50.0% and 55.6%).
Comment
This study has several notable limitations: It did not meet its target enrollment, it was conducted before the widespread adoption of immune checkpoint inhibitors, and it failed to achieve its primary objective of at least 50% 1-year OS without QoL deterioration in the SABR-alone arm — although the raw percentage was 55.2%, the lower bound of the confidence interval (0.38) fell below the targeted threshold (0.50). Nonetheless, I will consider using SABR alone for carefully selected patients with oligometastatic SCCHN, as it may be a viable alternative to standard chemotherapy with comparable survival outcomes. Importantly, SABR alone considerably preserved patients' quality of life and reduced severe treatment-related toxicities.
Citation(s)
Author:
Thariat J et al.
Title:
Survival without quality of life deterioration in the GORTEC 2014-04 “OMET” randomized phase 2 trial in patients with head and neck cancer with oligometastases using stereotactic ablative radiation therapy (SABR) alone or chemotherapy and SABR.
Source:
Int J Radiat Oncol Biol Phys
2025
Apr
1; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Hyunseok Kang, MD, MPH, FACP