Toxicity Profile of Stereotactic Body Radiotherapy for Oligometastatic Lymph Node Disease: A Critical Narrative Review

Stereotactic body radiotherapy (SBRT) has emerged as an effective metastasis-directed therapy for oligometastatic lymph node disease, providing high local control with minimal invasiveness. However, the proximity of lymph node metastases to critical organs raises concerns regarding treatment-related toxicity. This narrative review synthesizes current evidence on acute and late toxicity following SBRT for nodal oligometastases, highlighting incidence rates, anatomical risk factors, dosimetric considerations, and technical determinants of treatment safety. Available literature demonstrates a favorable safety profile, with severe toxicity rates generally below 1% when organ-at-risk constraints are respected. Nevertheless, re-irradiation, high biologically effective doses, large target volumes, and central anatomical locations remain significant predictors of complications. Understanding these factors is essential to optimize therapeutic ratio and ensure safe integration of SBRT into multimodal oncologic management.