Stereotactic body radiotherapy for oligometastatic ovarian cancer: Current evidence, patient selection, and future directions.

Abstract

Ovarian cancer recurs in a limited number of sites in a significant proportion of patients, raising interest in metastasis-directed therapy to delay systemic treatment escalation. Stereotactic body radiotherapy is increasingly used in this context. This review synthesises the available evidence on the role of stereotactic body radiotherapy in oligometastatic ovarian cancer, with emphasis on prospective data, patient selection criteria, integration with systemic therapies, and emerging technological approaches. The phase II trial MITO-RT3/RAD, first prospective, multicentre study in this setting reported excellent results in terms of complete response rates and local control at 12 months, with complete response emerging as a strong predictor of local control. The treatment was also very well tolerated, with no grade3 or worse toxicity and a low rate of grade 1-2 toxicity. Stereotactic body radiotherapy is a safe, effective metastasis-directed therapy option endorsed by current European guidelines. Key unresolved questions include the optimal integration with poly (ADP-ribose) polymerase inhibitors, the surgery versus stereotactic body radiotherapy comparison, and the management of peritoneal oligometastatic disease. The randomised ENGOT-ov74/LoRiO trial will address several of these gaps.