1. SABR Update
Breast SSG June 2017

2. SABR in Bristol First patient treated in February 2014
In past 3 years:
330 referrals
250 patients treated
Includes patients treated with oligometastatic disease through CtE
Areas treated include: lung, liver, adrenal, lymph node and bone

3. Referral Centers PLYMOUTH EXETER TORBAY BARNSTABLE TAUNTON YEOVIL BATH
UHB
NBT
GLOUCESTER
CHELTENHAM
WESTON

4. OVERALL SURVIVAL
OVERALL SURVIVAL AT 1 YEAR WAS 87% (95% CI 80 – 94%) AND 2 YEARS 78.8% (95% CI 66.8 – 90.8%).
THIS IS COMPARABLE WITH PUBLISHED DATA
PFS AND LRR WILL BE GENERATED ONCE WE HAVE FURTHER DATA FROM LOCAL CENTRES AND CENTRAL RADIOLOGY REVIEW

5. Case History: CT before and 12 months after treatment

6. But in reality……

7. Things are not quite so simple……

8. Indications for SABR Medically-inoperable lung cancer
Good evidence base; standard of care
Oligo-metastatic disease
Synchronous
Metachronous
Oligo-progressive disease
Progression in a small number of sites while patient on maintenance treatment
Stage IV disease
Combining SABR with systemic treatment - immunotherapy

9. Oligometastatic Disease: Randomised trials
SARON trial
synchronous metastatic disease in NSCLC
Sequential chemoRT followed SABR to up to 3 metastatic sites vs palliative chemo
CORE trial
metachronous disease in lung, breast and prostate
SABR to up to 3 metastatic sites vs standard of care
Must have minimum of 6 months disease free interval
HALT trial
oligoprogressive disease in patients with driver mutation
SABR and continued TKI vs change in systemic treatment

10. CORE trial schema Randomise (1:1) SBRT + Standard of Care
NSCLC, breast or prostate cancer patients
Completed radical treatment
≤3 extra cranial metachronous oligometastases
Suitable for SBRT
Randomise (1:1)
Standard of Care
SBRT +
Standard of Care
Standard of Care
defined prior to randomisation
May include further chemotherapy, hormone therapy, palliative radiotherapy or observation at PI discretion

11. Aims/Objectives Primary Secondary
To evaluate if the addition of SBRT to SoC improves PFS
Secondary

12. Secondary Aims/Objectives To demonstrate feasibility of recruitment
To demonstrate deliverability of SBRT within dosimetric constraints
To evaluate if the addition of SBRT to SoC improves OS
To evaluate the acute and late toxicity associated with the addition of SBRT to SoC
To evaluate the lesion local control rates in those receiving SBRT
To compare the quality of life (QoL) in patients receiving SBRT compared to those receiving SoC alone
To investigate and evaluate resource use and costs of SBRT and SoC therapy within the trial setting.