Clinical Research Papers:
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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Alessandro Ottaiano1,*, Valerio Scotti2,*, Chiara De Divitiis3, Monica Capozzi3, Carmen Romano3, Antonino Cassata3, Rossana Casaretti3, Lucrezia Silvestro3, Anna Nappi3, Valeria Vicario3, Alfonso De Stefano3, Salvatore Tafuto3, Massimiliano Berretta4, Guglielmo Nasti1 and Antonio Avallone3
1Department of Abdominal Oncology, SSD–Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori di Napoli G. Pascale IRCCS, National Cancer Institute, 80131, Naples, Italy
2San Rossore Clinic, Viale delle Cascine, 56122, Pisa, Italy
3Department of Abdominal Oncology, Experimental Clinical Oncology, Istituto Nazionale Tumori di Napoli G. Pascale IRCCS, National Cancer Institute, 80131, Naples, Italy
4Department of Medical Oncology, CRO Aviano, National Cancer Institute, 33081, Aviano, Italy
*These authors have contributed equally to this work
Keywords: colorectal cancer; radiation therapy; chemotherapy; metastatic colorectal cancer
Received: April 26, 2018 Accepted: June 23, 2018 Published: October 16, 2018
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.
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