Thread by @_ShankarSiva

1/ 🙏 patients, investigators and funders for
@TROGfightcancer 13.01 SAFRON II trial at #ESTRO21. n=90 pts with 133 pulmonary oligometastases, across 13 centers in 🇳🇿+🇦🇺. Median F/U = 3 years, randomization for single (SF) 28Gy vs 48Gy in 4fx (MF). #radonc #LCSM @PeterMacCC

2/ No difference in SF vs MF. Both were safe (G3+ AEs were 5% MF v 3% SF), and effective - 2yr OS 85% MF v 88% SF (p=0.44), LC 83% MF v 73% SF (p=0.13). No diff. in DFS (median 13.2 MF v 14.3 SF, p=0.99). Mean time to systemic treatment ~29mo. SABR did not impact QoL measures

3/ Both SF and MF arms drove systemic immune activation
- ⬆️%CD4+FoxP3+ Tregs, ⬆️ %CTLA-4 and %PD-1 expressing CD4+, CD8+ and/or CD4-CD8- T cell subsets
- modestly ⬆️ % change of CD4+ T cell and CD8+ T cell subsets expressing PD-1 or TIGIT in the SF arm as compared to MF arm

4/ Health Economics Analysis: TROG 13.01
- MF costs $1,121 AUD (30%) more than SF SABR.
- 2.43 QALYs in SF arm v 2.25 QALYs in MF arm.
- Major lifetime cost were post-progression therapies (i.e. systemic) at 5x initial costs; SF ($23,510) versus MF ($20,661) #lcsm #radonc

5/ TROG 13.01 SAFRON II is the first fully recruited randomized trial in patients with pulmonary oligometastases.
- SF picked as 'winner'
- outcomes comparable (? favorably) to surgery in PulMiCC study
- Equipoise for future RCT of SABR v surgery? #ESTRO2021 #LCSM #lungcancer

6/ Thank you @JAMAOnc for concurrently publishing the manuscript - found here, open access bit.ly/2Y8IOAb with editorial by @DrAryaAmin; in same edition - doi:10.1001/jamaoncol.2021.2926. 🙏🙏🙏 again for everyone's efforts, I'm very grateful!!!