Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters
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BRIEF RESEARCH ARTICLE
Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters S. Flamarique1 · M. Campo1 · G. Asín1 · S. Pellejero1 · A. Viúdez1,2 · F. Arias1 Received: 9 January 2020 / Accepted: 7 May 2020 © Federación de Sociedades Españolas de Oncología (FESEO) 2020
Abstract Purpose We analysed our initial experience with SBRT in liver metastasis from colorectal cancer at our institution. Materials and methods Between January/2014 and December/2017, 22 patients with 31 LMCCR were treated. Local control (LC) was assessed using the Kaplan–Meier and log-rank tests. We analysed potential prognostic factors for LC: sex, PTV size, number of LM and the radiation scheme. Results Median age: 69 years. Prior chemotherapy or local liver treatments: 81.8% and 63.6% of patients, respectively. SBRT consisted of 3 × 20 Gy (42.9%) and 3 × 15 Gy (31.4%). There were 88.5% responses (57.1% CR and 31.4% PR). Median follow-up was 30 months. LC per lesion at 12 and 24 months was 85.3% and 61.8%, respectively. Tumour volumes > 30 cc correlated with worsened 2-year-control rates (90% vs 34.5%) (p = 0.005). There was only a patient with CTC-grade 3 toxicity. Conclusions Liver SBRT is a safe and effective treatment that achieves high local control rates. We found a significant correlation between larger LMCRC and worse local control. Keywords Hepatic metastasis · Colorectal cancer · SBRT
Introduction Liver metastases (LM) develop in 30–70% of colorectal cancer patients [1]. For oligometastatic hepatic disease, surgical resection still remains the “gold standard” treatment, with long-term survival rates that range from 35 to 58% [2]. Nevertheless, less than 30% of patients with colorectal * F. Arias [email protected]; [email protected] S. Flamarique [email protected] M. Campo [email protected] G. Asín [email protected] S. Pellejero [email protected] A. Viúdez [email protected] 1
Radiation Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
Medical Oncology Department, Complejo Hospitalario de Navarra, Navarre, Spain
2
metastasis are suitable for resection because of tumour size and location, or medical conditions [2–4]. In patients with inoperable or unresectable disease, radiofrequency ablation (RFA) is the most widely used alternative procedure, which offers high rates of local control in liver metastasis from colorectal cancer (LMCRC) patients [5]. However, RFA has notable limitations, such as, size of metastasis (worse for tumours > 3 cm), the proximity of a major blood vessel or main biliary tract or lesions that are just beneath the liver surface [6]. Historically, the role of radiation therapy (RT) for the liver has been limited because of concerns about normal tissue tolerances. However, improvements of RT techniques, especially with the development of stereotactic body radiotherapy (SBRT), involving precise tumour imaging, highly conformal targets and motion management, have permitt
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