Quality of Life Outcomes After Stereotactic Ablative Radiation Therapy (SABR) Versus Standard of Care Treatments in the Oligometastatic Setting: A Secondary Analysis of the SABR-COMET Randomized Trial

Robert Olson, Suresh Senan, Stephen Harrow, Stewart Gaede, Alexander Louie, Cornelis Haasbeek, Liam Mulroy, Michael Lock, George Rodrigues, Brian Yaremko, Devin Schellenberg, Belal Ahmad, Gwendolyn Griffioen, Sashendra Senthi, Anand Swaminath, Neil Kopek, Mitchell Liu, Karen Moore, Suzanne Currie, Glenn BaumanAndrew Warner, David Palma

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Purpose: Randomized data assessing the longitudinal quality of life (QoL) impact of stereotactic ablative radiation therapy (SABR) in the oligometastatic setting are lacking. Methods and Materials: We enrolled patients who had a controlled primary malignancy with 1 to 5 metastatic lesions, with good performance status and life expectancy >6 months. We randomized in a 1:2 ratio between standard of care (SOC) treatment (SOC arm) and SOC plus SABR to all metastatic lesions (SABR arm). QoL was measured using the Functional Assessment of Cancer Therapy–General. QoL changes over time and between groups were assessed with linear mixed modeling. Results: Ninety-nine patients were randomized. Median age was 68 years (range, 43-89), and 60% were male. The most common primary tumor types were breast (n = 18), lung (n = 18), colorectal (n = 18), and prostate (n = 16). Most patients (n = 92) had 1 to 3 metastases. Median follow-up was 26 months. Because of the previously reported inferior survival of the SOC arm, the time for attrition in QoL respondents to <10% of subjects was shorter in the SOC versus SABR arm (30 vs 42 months). In the whole cohort, QoL declined over time after randomization: There were significant declines in total Functional Assessment of Cancer Therapy–General score over time compared with baseline (P <.001) owing to declines in physical and functional subscales (both P <.001), with no declines in social and emotional subscales. However, the magnitudes of decline were small, and clinically meaningful changes were not seen at most time points. Comparison between arms showed no differences in QoL between the SABR and SOC arms in total score (P =.42) or in the physical (P =.98), functional (P =.59), emotional (P =.82), or social (P =.17) subscales. Conclusions: For patients with oligometastases, average QoL declines slowly over time regardless of treatment approach, although the changes are small in magnitude. The use of SABR, compared with SOC, was not associated with a QoL detriment.

Original languageEnglish
Pages (from-to)943-947
Number of pages5
JournalInternational journal of radiation oncology, biology, physics
Issue number5
Early online date27 Aug 2019
Publication statusPublished - 1 Dec 2019

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