What question did this study set out to answer?

The study evaluates the effectiveness of stereotactic ablative radiotherapy in extending time to subsequent systemic therapy in children with recurrent or metastatic cancer.

May 29, 2026Open Access

Stereotactic Ablative Radiotherapy Extends Time to Subsequent Systemic Therapy in Pediatric Cancer Patients With Recurrent or Metastatic Disease

Key Points

The study evaluates the effectiveness of stereotactic ablative radiotherapy in extending time to subsequent systemic therapy in children with recurrent or metastatic cancer.
Conducted a single-institution retrospective analysis of pediatric patients receiving extracranial SAbR.
Patients underwent 2-5 fractions of SAbR for recurrent/progressive cancer from 2009 to 2024.
Primary endpoint measured was time from SAbR to next use of systemic therapy.
Cumulative incidence of any systemic therapy change at 12 months was 0.58 (95% CI 0.47–0.68).
Cumulative incidence of IV systemic therapy change was 0.36 (95% CI 0.26–0.47), median time to change was 11.9 months.
Median overall survival from first SAbR was 12.8 months (95% CI 7.82–26.20), with no significant association of local control with BED or EQD2.

Abstract

AbstractBackground and Aims Stereotactic ablative radiotherapy (SAbR) has been used in the adult population for decades, providing local control (LC) and, in some cases, overall survival (OS) advantage. It can also extend the time to subsequent systemic therapy, reducing side effect burden and improving quality of life. This retrospective study aimed to evaluate the effectiveness of SAbR in prolonging time to subsequent systemic therapy in children. Methods We performed a single-institution retrospective analysis of children who underwent extracranial SAbR over 2 – 5 fractions (dose per fraction > 5 Gray Gy) for recurrent or progressive cancer between 2009 and 2024. The primary endpoint was time from SAbR to next use of systemic therapy. Secondary endpoints included LC and OS, as well as the impact of biological effective dose (BED) and equivalent dose in 2-Gy fractions (EQD2) thereon. Results Thirty-five pediatric patients with cancer had 97 lesions that received at least one course of SAbR meeting minimum dose criteria (BED10 ≥30Gy). The cumulative incidence of any systemic therapy change at 12 months was 0.58 (95% CI 0.47–0.68). The cumulative incidence of IV systemic therapy change at 12 months was 0.36 (95% CI 0.26–0.47), with a median time to IV systemic therapy change of 11.9 months. Risk of local progression was associated with non-sarcoma histology compared with soft tissue sarcoma (Hazard Ratio HR 4.19; 95% Confidence Interval CI 1.25–14.06; p=0.021). Median OS from first SAbR was 12.8 months (95% CI 7.82–26.20). There was no statistically significant association of LC with BED or EQD2. Conclusions In this single-institution case series, SAbR was associated with a delay to subsequent IV systemic therapy change in pediatric cancer patients and may serve as a means to manage disease progression while minimizing burden of therapy. Prospective studies are needed to confirm these findings.

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