Abstract
Introduction
Some patients with cancer may present with progressive or persistent disease at a
limited number of sites following a period of treatment response. We evaluated the
safety and effectiveness of metastasis-directed radiotherapy (MRT) for oligoprogressive
or oligopersistent disease in patients receiving systemic treatment for metastatic
colorectal cancer (mCRC).
Patients and methods
Patients with mCRC who received 5-fluorouracil, leucovorin, and oxaliplatin; 5-fluorouracil,
leucovorin, and irinotecan; and/or capecitabine chemotherapy between 2011 and 2020
at a single institution were identified. Then, those who underwent MRT for five or
fewer lesion sites while receiving systemic treatment for other metastases were categorized.
The primary endpoint was time to change to systemic therapy. Secondary endpoints included
MRT-related toxicity, overall survival, and local control.
Results
Among 4157 patients included, 91 (2%) received MRT to limited lesion sites (55 oligoprogressive
and 36 oligopersistent) during systemic treatment following a period of treatment
response. The median time to change to next-line systemic therapy was 5 months in
the overall cohort (measured from the current chemotherapy session) and 9.5 (range,
6.0–40.6) months in the MRT group (measured from the MRT session). No severe toxicity
or systemic treatment interruption was observed following MRT. The 1-year local control
and overall survival rates were 69% and 99%, respectively.
Conclusion
In patients with oligoprogressive or oligopersistent mCRC, MRT may be performed safely
in conjunction with systemic treatment to maximize the benefit of systemic therapy
and to prolong the time to change to systemic therapy. Further prospective studies
should confirm these findings.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Colorectal CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment decisions in metastatic colorectal cancer - Beyond first and second line combination therapies.Cancer Treat Rev. 2017; 59: 54-60
- Distant metastasis occurs late during the genetic evolution of pancreatic cancer.Nature. 2010; 467: 1114-1117
- Intratumor heterogeneity and branched evolution revealed by multiregion sequencing.N Engl J Med. 2012; 366: 883-892
- Oligometastases revisited.Nat Rev Clin Oncol. 2011; 8: 378-382
- The use of radiation therapy for oligoprogressive/oligopersistent oncogene-driven non small cell lung cancer: State of the art.Crit Rev Oncol Hematol. 2020; 148102894
- Definition, Biology, and History of Oligometastatic and Oligoprogressive Disease.Cancer J. 2020; 26: 96-99
- The Role of Maintenance Strategies in Metastatic Colorectal Cancer: A Systematic Review and Network Meta-analysis of Randomized Clinical Trials.JAMA Oncol. 2020; 6e194489
- Is there a role for consolidative stereotactic body radiation therapy following first-line systemic therapy for metastatic lung cancer? A patterns-of-failure analysis.Acta Oncol. 2009; 48: 578-583
- Incorporation of radiotherapy in the multidisciplinary treatment of isolated retroperitoneal lymph node recurrence from colorectal cancer.Ann Surg Oncol. 2015; 22: 1520-1526
- Assessment of efficiency and safety of the comprehensive chemotherapy assistance program for ordering oncology medications.Int J Med Inform. 2013; 82: 504-513
- Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation.Lancet Oncol. 2020; 21: e18-e28
- Comparison of survival and prognostic factors in patients treated with stereotactic body radiotherapy for oligometastases or oligoprogression.Radiother Oncol. 2018; 127: 493-500
- Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial.J Clin Oncol. 2018; 36: 446-453
- Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): Five-year results of a randomized phase II trial.J Clin Oncol. 2020; 38: 10
- Progression-directed Therapy for Oligoprogression in Castration-refractory Prostate Cancer.Eur Urol Oncol. 2021; 4: 305-309
- Metastasis directed stereotactic radiotherapy in NSCLC patients progressing under targeted- or immunotherapy: efficacy and safety reporting from the 'TOaSTT' database.Radiat Oncol. 2021; 16: 4
- A phase II multicenter study of stereotactic radiotherapy (SRT) for oligoprogression in metastatic renal cell cancer (mRCC) patients receiving tyrosine kinase inhibitor (TKI) therapy.J Clin Oncol. 2020; 38: 5065
- Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study.J Clin Oncol. 2019; 37: 1558-1565
- Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial.J Clin Oncol. 2020; 38: 2830-2838
- Outcomes of extra-cranial stereotactic body radiotherapy for metastatic colorectal cancer: Dose and site of metastases matter.Radiother Oncol. 2020; 142: 236-245
- Pattern of Failure Analysis in Metastatic EGFR-Mutant Lung Cancer Treated with Tyrosine Kinase Inhibitors to Identify Candidates for Consolidation Stereotactic Body Radiation Therapy.J Thorac Oncol. 2015; 10: 1601-1607
- Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer.J Clin Oncol. 2014; 32: 3824-3830
- EGFR tyrosine kinase inhibitors beyond focal progression obtain a prolonged disease control in patients with advanced adenocarcinoma of the lung.Lung Cancer. 2013; 81: 440-444
- Metastasis-directed Therapy Prolongs Efficacy of Systemic Therapy and Improves Clinical Outcomes in Oligoprogressive Castration-resistant Prostate Cancer.Eur Urol Oncol. 2021; 4: 447-455
- Stereotactic ablative radiotherapy and systemic treatments for extracerebral oligometastases, oligorecurrence, oligopersistence and oligoprogression from lung cancer.BMC Cancer. 2019; 19: 1237
- Stereotactic radiation therapy in oligometastatic colorectal cancer: outcome of 102 patients and 150 lesions.Clin Exp Metastasis. 2019; 36: 331-342
- Association of tumor genomic factors and efficacy for metastasis-directed stereotactic body radiotherapy for oligometastatic colorectal cancer.Radiother Oncol. 2020; 146: 29-36
- Stereotactic body radiotherapy for oligo-metastatic liver disease - Influence of pre-treatment chemotherapy and histology on local tumor control.Radiother Oncol. 2017; 123: 227-233
- Superior outcomes of nodal metastases compared to visceral sites in oligometastatic colorectal cancer treated with stereotactic ablative radiotherapy.Radiother Oncol. 2020; 151: 280-286
- Stereotactic Radiotherapy for Oligometastasis.Cancers (Basel). 2013; 81: 440--444
Article info
Publication history
Published online: November 18, 2021
Accepted:
October 7,
2021
Received in revised form:
October 6,
2021
Received:
August 26,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
