Discussionĭespite its almost universal use in (oligo-)metastatic patients, the level of evidence supporting radical local treatment in general, and stereotactic radiotherapy in particular, is low. Liquid biopsies will be collected throughout the course of this study from the second fractionation schedule on. Acute and late toxicity, local response and local recurrence, and progression-free survival are secondary endpoints. Dose-limiting toxicity will be recorded as primary endpoint. They will be offered stereotactic ablative radiotherapy in 5, 3 or 1 fractions. A total of 90 patients will be included in three different treatment regimens. The DESTROY-trial is a non-randomized prospective phase I trial determining a regimen of choice for patients with non-spine bone and lymph node metastases. However, when SABR is considered for non-spine bone or lymph node metastases, the optimal fractionation schedule is not yet known. There is also emerging evidence that SABR can stimulate the immune response, and a specific therapeutic window may exist for the optimal use of radiotherapy as an immune adjuvant. In addition, the radiobiological qualities of SABR are promising for the use in perceived radioresistant tumours. Stereotactic ablative radiotherapy (SABR) is one of the treatment modalities that can be offered to these patients. In an oligometastatic setting, metastasis-directed treatment could render patients disease free, possibly for a protracted interval.
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