Stereotactic Ablative Radiation Therapy for Colorectal Liver Metastases
•Stereotactic Ablative Radiation Therapy (SABR) is an effective and well tolerated treatment option for selected patients with liver metastases from colorectal cancer.•SABR for colorectal liver metastases requires higher biological effective doses to provide adequate local control.•SABR to colorecta...
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| Published in: | Clinical colorectal cancer Vol. 22; no. 1; pp. 120 - 128 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Elsevier Inc
01-03-2023
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Stereotactic Ablative Radiation Therapy (SABR) is an effective and well tolerated treatment option for selected patients with liver metastases from colorectal cancer.•SABR for colorectal liver metastases requires higher biological effective doses to provide adequate local control.•SABR to colorectal liver metastases may provide patients with a delay to starting or recommencing systemic therapy.
Stereotactic Ablative Radiation Therapy (SABR) is a therapeutic option for patients with inoperable oligometastatic colorectal carcinoma (CRC). Given the scarcity of prospective data on outcomes of SABR for metastatic CRC, this study aims to review SABR outcomes and determine predictive factors of local control (LC) and survival in patients with liver metastases from CRC.
A retrospective review of SABR for CRC liver metastases between 2011 and 2019 was undertaken. Endpoints included LC, overall survival (OS), progression-free survival (PFS) and time to restarting systemic therapy. Univariate (UVA) and multivariable analyses (MVA) were performed to identify predictive factors.
Forty-eight patients were identified. The total number of tumors treated was 58. Median follow-up was 26.6 months. LC at 1, 2 and 3 years was 92.7%, 80.0%, and 61.2% respectively. Median time to local failure was 40.0 months (95% CI 31.8-76.1 months). Median OS was 31.9 months (95% CI 20.6-40.0 months). OS at 1, 2, and 3 years was 79.2%, 61.7%, and 44.9% respectively. Thirty-three patients (69%) restarted systemic therapy after completion of SABR. Median time to restarting chemotherapy was 11.0 months (95% CI 7.1-17.6 months). Systemic therapy free survival at 1, 2, and 3 years was 45.7%, 29.6%, and 22.6% respectively. On MVA, inferior LC was influenced by GTV volume ≥40 cm3 (HR: 3.805, 95% CI 1.376-10.521, P = .01) and PTV D100% BED <100 Gy10 (HR 2.971, 95% CI 1.110-7.953; P = .03). Inferior OS was associated with PTV volume ≥200 cm3 (HR 5.679, 95% CI 2.339-13.755; P < .001).
SABR is an effective therapeutic option for selected patients with CRC liver metastases providing acceptable LC within the first 2 years. In many cases, it provides meaningful chemotherapy-free intervals. Higher biological effective doses are required to enhance LC.
This retrospective report of SABR of 58 treated colorectal liver metastases in 48 patients describes local control at 2 years of 80.0%. Median overall survival was 31.9 months. Local control was adversely impacted by larger tumour volumes and lower BED used. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 1533-0028 1938-0674 |
| DOI: | 10.1016/j.clcc.2022.10.006 |