Integration of stereotactic radiotherapy in the treatment of metastatic colorectal cancer patients

A real practice study with long-term outcome and prognostic factors

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Abstract

Background: There are very few clinical or prognostic studies on the role of SRT (Stereotactic Radiation Therapy) in the continuum of care of metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients affected by oligo-mCRC were treated with SRT before or after front-line standard treatments. SRT was delivered according to a risk-adapted protocol. Total body CT (Computed Tomography) scan was done before therapy and every three months thereafter. The radiologic responses to therapy were evaluated by RECIST (Response Evaluation Criteria In Solid Tumors). FDG-PET (FluoroDeoxyGlucose - Positron Emission Tomography) was done before and after SRT; metabolic responses were evaluated by using the EORTC (European Organization for Research and Treatment of Cancer) criteria. The Kaplan-Meier product limit method was applied to graph Overall Survival (OS) and Progression-Free Survival (PFS). Results: Forty-seven patients were included. Twenty-one patients had disease limited to lungs, 9 to lung and liver, 7 only to liver, 10 to multiple sites. The median prescription SRT dose was 60 Gy per organ in 3 fractions (median biological effective dose of 180 Gy). The reduction of delta SUVmax (maximum Standardized Uptake Value) correlated with the local control (p<0.001) and two-years survival (p=0.003). At univariate analysis, localization of primary tumor, site of metastases, KRAS (Kirsten RAt Sarcoma) oncogene mutational status, response to first-line chemotherapy, response to SRT and number of treated lesions predicted both PFS and OS. Discussion: This real practice experience suggests that further studies are needed to analyze the promising role of SRT in the multidisciplinary management of mCRC.

Original languageEnglish
Pages (from-to)35251-35265
Number of pages15
JournalOncotarget
Volume9
Issue number81
Publication statusPublished - Oct 1 2018

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Colorectal Neoplasms
Radiotherapy
Therapeutics
Disease-Free Survival
Survival
Lung
Continuity of Patient Care
Liver
Kaplan-Meier Estimate
Oncogenes
Sarcoma
Positron-Emission Tomography
Prescriptions
Neoplasms
Tomography
Neoplasm Metastasis
Drug Therapy
Research

Keywords

  • Chemotherapy
  • Colorectal cancer
  • Metastatic colorectal cancer
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology

Cite this

@article{9350a70cb81d4e4786fbb203396cd8cd,
title = "Integration of stereotactic radiotherapy in the treatment of metastatic colorectal cancer patients: A real practice study with long-term outcome and prognostic factors",
abstract = "Background: There are very few clinical or prognostic studies on the role of SRT (Stereotactic Radiation Therapy) in the continuum of care of metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients affected by oligo-mCRC were treated with SRT before or after front-line standard treatments. SRT was delivered according to a risk-adapted protocol. Total body CT (Computed Tomography) scan was done before therapy and every three months thereafter. The radiologic responses to therapy were evaluated by RECIST (Response Evaluation Criteria In Solid Tumors). FDG-PET (FluoroDeoxyGlucose - Positron Emission Tomography) was done before and after SRT; metabolic responses were evaluated by using the EORTC (European Organization for Research and Treatment of Cancer) criteria. The Kaplan-Meier product limit method was applied to graph Overall Survival (OS) and Progression-Free Survival (PFS). Results: Forty-seven patients were included. Twenty-one patients had disease limited to lungs, 9 to lung and liver, 7 only to liver, 10 to multiple sites. The median prescription SRT dose was 60 Gy per organ in 3 fractions (median biological effective dose of 180 Gy). The reduction of delta SUVmax (maximum Standardized Uptake Value) correlated with the local control (p<0.001) and two-years survival (p=0.003). At univariate analysis, localization of primary tumor, site of metastases, KRAS (Kirsten RAt Sarcoma) oncogene mutational status, response to first-line chemotherapy, response to SRT and number of treated lesions predicted both PFS and OS. Discussion: This real practice experience suggests that further studies are needed to analyze the promising role of SRT in the multidisciplinary management of mCRC.",
keywords = "Chemotherapy, Colorectal cancer, Metastatic colorectal cancer, Radiation therapy",
author = "Alessandro Ottaiano and Valerio Scotti and {De Divitiis}, Chiara and Monica Capozzi and Carmen Romano and Antonino Cassata and Rossana Casaretti and Lucrezia Silvestro and Anna Nappi and Valeria Vicario and {De Stefano}, Alfonso and Salvatore Tafuto and Massimiliano Berretta and Guglielmo Nasti and Antonio Avallone",
year = "2018",
month = "10",
day = "1",
language = "English",
volume = "9",
pages = "35251--35265",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals LLC",
number = "81",

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TY - JOUR

T1 - Integration of stereotactic radiotherapy in the treatment of metastatic colorectal cancer patients

T2 - A real practice study with long-term outcome and prognostic factors

AU - Ottaiano, Alessandro

AU - Scotti, Valerio

AU - De Divitiis, Chiara

AU - Capozzi, Monica

AU - Romano, Carmen

AU - Cassata, Antonino

AU - Casaretti, Rossana

AU - Silvestro, Lucrezia

AU - Nappi, Anna

AU - Vicario, Valeria

AU - De Stefano, Alfonso

AU - Tafuto, Salvatore

AU - Berretta, Massimiliano

AU - Nasti, Guglielmo

AU - Avallone, Antonio

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: There are very few clinical or prognostic studies on the role of SRT (Stereotactic Radiation Therapy) in the continuum of care of metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients affected by oligo-mCRC were treated with SRT before or after front-line standard treatments. SRT was delivered according to a risk-adapted protocol. Total body CT (Computed Tomography) scan was done before therapy and every three months thereafter. The radiologic responses to therapy were evaluated by RECIST (Response Evaluation Criteria In Solid Tumors). FDG-PET (FluoroDeoxyGlucose - Positron Emission Tomography) was done before and after SRT; metabolic responses were evaluated by using the EORTC (European Organization for Research and Treatment of Cancer) criteria. The Kaplan-Meier product limit method was applied to graph Overall Survival (OS) and Progression-Free Survival (PFS). Results: Forty-seven patients were included. Twenty-one patients had disease limited to lungs, 9 to lung and liver, 7 only to liver, 10 to multiple sites. The median prescription SRT dose was 60 Gy per organ in 3 fractions (median biological effective dose of 180 Gy). The reduction of delta SUVmax (maximum Standardized Uptake Value) correlated with the local control (p<0.001) and two-years survival (p=0.003). At univariate analysis, localization of primary tumor, site of metastases, KRAS (Kirsten RAt Sarcoma) oncogene mutational status, response to first-line chemotherapy, response to SRT and number of treated lesions predicted both PFS and OS. Discussion: This real practice experience suggests that further studies are needed to analyze the promising role of SRT in the multidisciplinary management of mCRC.

AB - Background: There are very few clinical or prognostic studies on the role of SRT (Stereotactic Radiation Therapy) in the continuum of care of metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients affected by oligo-mCRC were treated with SRT before or after front-line standard treatments. SRT was delivered according to a risk-adapted protocol. Total body CT (Computed Tomography) scan was done before therapy and every three months thereafter. The radiologic responses to therapy were evaluated by RECIST (Response Evaluation Criteria In Solid Tumors). FDG-PET (FluoroDeoxyGlucose - Positron Emission Tomography) was done before and after SRT; metabolic responses were evaluated by using the EORTC (European Organization for Research and Treatment of Cancer) criteria. The Kaplan-Meier product limit method was applied to graph Overall Survival (OS) and Progression-Free Survival (PFS). Results: Forty-seven patients were included. Twenty-one patients had disease limited to lungs, 9 to lung and liver, 7 only to liver, 10 to multiple sites. The median prescription SRT dose was 60 Gy per organ in 3 fractions (median biological effective dose of 180 Gy). The reduction of delta SUVmax (maximum Standardized Uptake Value) correlated with the local control (p<0.001) and two-years survival (p=0.003). At univariate analysis, localization of primary tumor, site of metastases, KRAS (Kirsten RAt Sarcoma) oncogene mutational status, response to first-line chemotherapy, response to SRT and number of treated lesions predicted both PFS and OS. Discussion: This real practice experience suggests that further studies are needed to analyze the promising role of SRT in the multidisciplinary management of mCRC.

KW - Chemotherapy

KW - Colorectal cancer

KW - Metastatic colorectal cancer

KW - Radiation therapy

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M3 - Article

VL - 9

SP - 35251

EP - 35265

JO - Oncotarget

JF - Oncotarget

SN - 1949-2553

IS - 81

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