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Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy

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A Letter to the Editor to this article was published on 26 November 2020

Abstract

Purpose

Stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) has been shown to increase survival rates in oligometastatic disease (OMD), but local control of colorectal metastases remains poor. We aimed to explore the natural course of oligometastatic colorectal cancer and to investigate how SBRT of lung metastases can delay the progression to polymetastatic disease (PMD).

Methods

107 lung oligometastases in 38 patients were treated with SBRT at a single institution. The median number of treated lesions was 2 (range 1–5). Time to PMD (ttPMD) was defined as the time from SBRT to the occurrence of >5 new metastases. Genetic biomarkers such as EGFR, KRAS, NRAS, BRAF, and microsatellite instability were investigated as predictive factors for response rates.

Results

Median follow-up was 28 months. At median follow-up, 7 patients were free from disease and 31 had progression: 18 patients had sequential oligometastatic disease (SOMD) and 13 polymetastatic progression. All SOMD cases received a second SBRT course. Median progression-free survival (PFS) was 7 months (range 4–9 months); median ttPMD was 25.8 months (range 12–39 months) with 1‑ and 2‑year PFS rates of 62.5% and 53.4%, respectively. 1‑ and 2‑year local PFS (LPFS) rates were 91.5% and 80%, respectively. At univariate analysis, BRAF wildtype correlated with better LPFS (p = 0.003), SOMD after primary SBRT was associated with longer cancer-specific survival (p = 0.031). Median overall survival (OS) was 39.5 months (range 26–64 months) and 2‑year OS was 71.1%.

Conclusion

The present results support local ablative treatment of lung metastases using SBRT in oligometastatic colorectal cancer patients, as it can delay the transition to PMD. Patients who progressed as SOMD maintained a survival advantage compared to those who developed PMD.

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Authors and Affiliations

  1. Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy

    Luca Nicosia, Francesco Cuccia, Rosario Mazzola, Francesco Ricchetti, Vanessa Figlia, Niccolò Giaj-Levra, Michele Rigo, Ruggero Ruggieri & Filippo Alongi

  2. Radiation Oncology Department, ASST Spedali Civili di Brescia, Brescia University, Brescia, Italy

    Davide Tomasini

  3. Department of Radiation Oncology, Ospedale di Esine, ASL Valle Camonica-Sebino Esine, Esine, Italy

    Nadia Pasinetti

  4. Radiation Oncology Department, University Hospital, LMU Munich, Munich, Germany

    Stefanie Corradini

  5. University of Brescia, Brescia, Italy

    Filippo Alongi

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  1. Luca Nicosia
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Correspondence to Luca Nicosia.

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L. Nicosia, F. Cuccia, R. Mazzola, F. Ricchetti, V. Figlia, N. Giaj-Levra, M. Rigo, D. Tomasini, N. Pasinetti, S. Corradini, R. Ruggieri, and F. Alongi declare that they have no competing interests.

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Nicosia, L., Cuccia, F., Mazzola, R. et al. Disease course of lung oligometastatic colorectal cancer treated with stereotactic body radiotherapy. Strahlenther Onkol 196, 813–820 (2020). https://doi.org/10.1007/s00066-020-01627-7

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