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Stereotactic radiation therapy in oligometastatic colorectal cancer: outcome of 102 patients and 150 lesions

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Abstract

To evaluate the local control (LC), progression free survival (PFS), out-field PFS, overall survival (OS), toxicity and failure predictors of SRT in a series of various sites oligometastatic CRC patients. Patients with oligometastatic CRC disease were analyzed retrospectively. The SRT prescribed dose was dependent on the lesion volume and its location. 102 consecutive oligometastatic CRC patients (150 lesions) were included. They underwent SRT between 2012 and 2015. Median prescription dose was 45 Gy (median dose/fraction was 15 Gy/3 fractions biological equivalent dose (BED10) 112.5 Gy). Median follow-up was 11.4 months. No patients experienced G3 and G4 toxicity. No progression was found in 82% (radiological response at 3 months) and 85% (best radiological response) out of 150 evaluable lesions. At 1 and 2 years: LC was 70% and 55%; OS was 90% and 90%; PFS was 37% and 27%; out-field PFS was 37% and 23% respectively. Progressive disease was correlated with BED10 (better LC when BED10 was ≥ 75 Gy (p < 0.0001)). In multivariate analysis, LC was higher in lesions with a Plpnning target volume (PTV) volume < 42 cm3 and BED10 ≥ 75 Gy. Patients with Karnofsky performance status < 90 showed higher out-field progression. SRT is an effective treatment for patients with oligometastases from CRC. Its low treatment-associated morbidity and acceptable LC make of SRT an option not only in selected cases. Further studies should be focused to clarify which patient subgroup will benefit most from this treatment modality and to define the optimal dose to improve LC while maintaining low toxicity profile.

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Acknowledgements

This study was partially supported by Fondazione IEO-CCM, project entitled “AXILL-ART: Biology-based radiotherapy volume definition for 1–2 macrometastatic sentinel lymph nodes without further dissection in breast cancer conservative surgery” and by a research grant from Accuray Inc. entitled “Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies and prostate study”. The Sponsor did not play any role in the study design, collection, analysis and interpretation of data, nor in the writing of the manuscript, nor in the decision to submit the manuscript for publication.

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    Authors and Affiliations

    1. Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

      V. Dell’Acqua, A. Surgo, Maria Alessia Zerella, D. Ciardo, C. Fodor, A. M. Ferrari, G. Piperno, M. C. Leonardi & B. A. Jereczek-Fossa

    2. Division of Oncology, University Hospital Centre “Mother Theresa”, Rruga e Dibrës 372, 1000, Tirana, Albania

      F. Kraja

    3. Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210, Gdańsk, Poland

      J. Kobiela & P. Spychalski

    4. Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy

      Maria Alessia Zerella & B. A. Jereczek-Fossa

    5. Group Leader Department of Experimental Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

      S. Gandini

    6. Palliative Care and Pain Therapy Unit, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

      C. M. Francia

    7. Unit of Medical Physics, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

      F. Cattani, S. Vigorito & F. Pansini

    8. Division of Gastrointestinal Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

      W. Petz

    9. Scientific Directorate, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy

      R. Orecchia

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    1. V. Dell’Acqua
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    Correspondence to Maria Alessia Zerella.

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    V. Dell’Acqua and A. Surgo are co-first authors. M. C. Leonardi and B. A. Jereczek-Fossa are co-last authors.

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    Dell’Acqua, V., Surgo, A., Kraja, F. et al. Stereotactic radiation therapy in oligometastatic colorectal cancer: outcome of 102 patients and 150 lesions. Clin Exp Metastasis 36, 331–342 (2019). https://doi.org/10.1007/s10585-019-09976-z

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