In 2024 we can safely say that stereotactic body irradiation is the standard for oligomets, but how safe is it in the femur, the bone famous for supporting the compressive force of many-fold our total body weight? This helpful series of 48 patients receiving SBRT (18-20 Gy / 1, 27-30 Gy / 3, or 28.5-40 Gy / 5) to 53 femur lesions (none with prior fixation) suggests it is, indeed, very safe. At a median follow-up of 1.5 years, there was one fracture and three instances of post-radiation internal fixation (one for pain and two for osteonecrosis) with none having persistent disease on path. Local control was an impressive 89% at 2 years. What’s perhaps most interesting is five failures outside the field but within 5 cm of the target posing a big question mark on how big our low-dose expansions should be to cover microscopic disease. | Kwan, Adv Radiat Oncol 2024
