Outcomes of Stereotactic Body Radiotherapy for Metastatic Colorectal Cancer With Oligometastases, Oligoprogression, or Local Control of Dominant Tumors

Abstract

AimTo evaluate the clinical outcomes of metastatic colorectal cancer (mCRC) patients with oligometastases, oligoprogression, or local control of dominant tumors after stereotactic body radiotherapy (SBRT) and establish a nomogram model to predict the prognosis for these patients.Methods and MaterialsA cohort of 94 patients with 162 mCRC metastases was treated with SBRT at a single institution. Treatment indications were oligometastases, oligoprogression, and local control of dominant tumors. End points of this study were the outcome in terms of progression-free survival (PFS), overall survival (OS), local progression (LP), and cumulative incidence of starting or changing systemic therapy (SCST). In addition, univariate and multivariable analyses to assess variable associations were performed. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve.ResultsMedian PFS were 12.6 months, 6.8 months, and 3.7 months for oligometastases, oligoprogression, and local control of dominant tumors, respectively. 0-1 performance status, < 10 ug/L pre-SBRT CEA, and ≤ 2 metastases were significant predictors of higher PFS on multivariate analysis. Median OS were 40.0 months, 26.1 months, and 6.5 months for oligometastases, oligoprogression, and local control of dominant tumors, respectively. In the multivariate analysis of the cohort, the independent factors for survival were indication, performance status, pre-SBRT CEA, and PTV, all of which were selected into the nomogram. The calibration curve for probability of survival showed the good agreement between prediction by nomogram and actual observation. The C-index of the nomogram for predicting survival was 0.848.ConclusionsSBRT for metastases derived from colorectal cancer offered favorable survival and symptom palliation without significant complications. The proposed nomogram could provide individual prediction of OS for patients with mCRC after SBRT.

Knowing When to Use Stereotactic Ablative Radiation Therapy in Oligometastatic Cancer

“…Volume of metastases correlated with LC in 3 series 21,24,25 and with OS in 6 studies. 19,23,[25][26][27][28] Total number of metastases treated with SABR was not a clear prognostic factor according to our analysis. Limited number (< 3) of metastases improved LC in one study 29 and OS in two.…”

“…Limited number (< 3) of metastases improved LC in one study 29 and OS in two. 22,28 In a retrospective study LC was significantly better for pulmonary oligometastases from rectal cancer compared to those from colon cancer. 17 The reason is unknown.…”

“… N.A. 31 83% (2yrs) 81% (3yrs) 77% (5yrs) 69% (2yrs) 55% (3yrs) 36% (5yrs) 38% (2yrs) 29% (3yrs) 21% (5yrs) OS: - male gender (HR 0.52, p-value 0.025) -age < 70 years (HR 0.52, p-value 0.024) OS: -single metastasis (HR 0.37, p-value 0.046) LC: -BED < 100 Gy (HR 3.67, p-value < 0.001) -pre-SABR chemotherapy (HR 2.66, p-value 0.020) OS: -BED ≥100Gy (HR 0.52, p-value 0.017) Ji, 28 2021 Retrospective 94/162 61 Lung (29%) Liver (23%) Nodes (26%) Other (22%) N.A. 100 Gy 36.4 94.1% (1y) 26.9 mos (median) 7 mos (median) OS: -Performance Status 2–3 (HR 3.51, p-value 0.001) PFS: -Performance Status 2–3 (HR 1.86, p-value 0.020) PFS: Number of metastases > 2 (HR 2.76, p-value 0.001) -pre-SABR CEA > 100 ug/L (HR 2.08, p=0.013) OS: -pre-SABR CEA > 100 ug/L (HR 2.60, p-value 0.011) OS: -PTV ≤ 30cc (HR 3.69, p-value 0.000) Thomson, 19 2020 Retrospective 165/262 69 Lung (47%) Liver (36%) Spine (10%) Other (7%) 24–60 Gy/2–5 fr 107 Gy 22 90.5% (1y) 76.2% (2yrs) 73.1% (3yrs) 49.3 mos (median) 12.4 mos (median) N.A.…”

The short-term and oncologic outcomes of younger VS older colorectal cancer patients undergoing primary surgery: a propensity score matching analysis

“…Colorectal cancer (CRC) is one of the most common cancers with approximate 185 million cases worldwide [ 1 ], in addition, CRC is one of the most common causes of cancer-related deaths, with nearly 700,000 deaths every year [ 2 ]. Radical surgery is the cornerstone of CRC treatment [ 3 – 5 ].…”

Higher body mass index was associated with better prognosis in diabetic patients with stage II colorectal cancer

“…Although there are many treatments for CRC including surgery, radiotherapy, and chemotherapy. Radical surgery is still the cornerstone of the treatment of CRC [ 3 – 5 ].…”