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Stereotactic Ablative Radiation Therapy for Colorectal Liver Metastases

Published:November 10, 2022DOI:https://doi.org/10.1016/j.clcc.2022.10.006

      Highlights

      • 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

      ABSTRACT

      Purpose

      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 and survival in patients with liver metastases from CRC.

      Materials and Methods

      A retrospective review of SABR for CRC liver metastases between 2011 and 2019 was undertaken. Endpoints included local control (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.

      Results

      48 patients were identified. The total number of tumours treated was 58. Median follow-up was 26.6 months. Local control 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 overall survival was 31.9 months (95% CI 20.6 – 40.0 months). Overall survival at 1, 2 and 3 years was 79.2%, 61.7% and 44.9% respectively. 33 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 local control was influenced by GTV volume ≥40cm
      • Leporrier J
      • Maurel J
      • Chiche L
      • et al.
      A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer.
      (HR: 3.805, 95% CI 1.376-10.521, p=0.01) and PTV D100% BED <100Gy10 (HR 2.971, 95% CI 1.110-7.953; p=0.03). Inferior overall survival was associated with PTV volume ≥200cm
      • Leporrier J
      • Maurel J
      • Chiche L
      • et al.
      A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer.
      (HR 5.679, 95% CI 2.339-13.755; p<0.001).

      Conclusions

      SABR is an effective therapeutic option for selected patients with CRC liver metastases providing acceptable local control within the first two years. In many cases, it provides meaningful chemotherapy-free intervals. Higher biological effective doses are required to enhance local control.
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