Elsevier

Radiotherapy and Oncology

Volume 144, March 2020, Pages 23-29
Radiotherapy and Oncology

Original Article
Prognostic factors for local control and survival for inoperable pulmonary colorectal oligometastases treated with stereotactic body radiotherapy

https://doi.org/10.1016/j.radonc.2019.10.004Get rights and content

Highlights

  • SBRT was associated with 2- year LC of 83% and 2- year OS of 69%.

  • BED10 ≥ 100 Gy, male gender, age < 70 yrs & single metastasis were associated with better OS.

  • SBRT dose ≥ 100 Gy BED10 was independently associated with both better OS and LC.

Abstract

Purpose

The study aimed to evaluate overall survival and local control, and to identify factors independently associated with overall survival (OS) and local control (LC).

Materials and methods

This retrospective study examined 118 patients with primary colorectal cancer, in whom 202 inoperable pulmonary oligometastases were treated with stereotactic body radiotherapy between 2005 and 2015. Primary endpoint was to evaluate OS and identify prognostic factors associated with OS. Secondary aim was to evaluate LC and identify prognostic factors associated with LC.

Results

Median follow-up was 31 months (range 3–88 months). Median OS was 39.2 months (95% CI 34.8–43.6 months). Two-, three-, and five-year OS was 69%, 55% and 36%, respectively. LC at 2-, 3-, and 5-year was 83%, 81% and 77% respectively. Factors independently associated with OS in the multivariable analysis included BED10 ≥ 100 Gy (HR 0.52), male gender (HR 0.52), age < 70 years (HR 0.52) and presence of single metastasis (HR 0.37). BED10 < 100 Gy (HR 3.67) and pre-SBRT chemotherapy (HR 2.66) were independently associated with poor LC in a multivariable analysis.

Conclusions

SBRT was associated with 2- year OS of 69% and 2-year LC of 83%. SBRT dose ≥ 100 Gy BED10 was independently associated with both better overall survival and local control.

Section snippets

Patient selection

This retrospective study included 202 inoperable pulmonary metastases in 118 CRC patients were treated with SBRT from the year 2005 to 2015. Selection criteria for oligometastases included: metastatic disease limited to a maximum of 2 organs and in total no more than 5 metastatic lesions at time of treatment. All oligometastases were treated with either surgery, SBRT, radiofrequency ablation (RFA) or microwave ablation, depending on multidisciplinary tumor board recommendation. The study was

Results

Patient and tumor characteristics are shown in Table 1. The majority of patients (n = 83) had metachronous tumors. One hundred and three patients had more than one metastasis, and extra pulmonary metastases were present in 69 patients. Seventy-three patients received chemotherapy before start of the SBRT.

Median OS was 39.2 months (95% CI 34.8–43.6 months). In total, 55 patients (47%) died and the 2-, 3-, and 5-year OS rates were 69%, 55% and 36%, respectively (Fig. 1a). Median follow-up was

Discussion

In our study, SBRT to pulmonary oligometastases was associated with 2- and 5-year OS rates of 69% and 36%, respectively. SBRT is often offered to patients not fit for other treatment modalities, either due to medical comorbidities, worse general condition or location of metastases. All these parameters can negatively influence OS. Majority of studies evaluating SBRT for pulmonary oligometastases have small sample sizes [14], [15], [16], [17], [18], [19], [20], [21], [22] or include

Conflicts of interest

None.

Acknowledgment

None.

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