Guler Ozan Cem, Hurmuz Pervin, Atalar Banu, Guney Yıldız, Saglam Esra Kaytan, Akyurek Serap, Bolukbasi Yasemin, Gural Zeynep, Tugrul Fuzuli, Korcum Aylin, Sen Cenk Ahmet, Yildirim Berna Akkus, Oksuz Didem Colpan, Kurt Meral, Guzeloz Zeliha, Aksu Gorkem, Saynak Mert, Aksu Gamze, Onal Cem
Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey.
Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Strahlenther Onkol. 2024 Nov;200(11):958-966. doi: 10.1007/s00066-024-02291-x. Epub 2024 Aug 19.
To investigate the treatment outcomes of extracranial oligometastatic colorectal cancer (CRC) patients treated with stereotactic body radiotherapy (SBRT).
The clinical data of 388 extra-cranial oligometastatic CRC (≤ 5 lesions) patients and 463 lesions treated with SBRT at 19 cancer institutions were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local control (LC) were assessed in uni- and multivariable analyses.
The median age was 62 years (range, 29-92 years). The majority of the patients (90.5%) received surgery and systemic treatment for their primary tumor, had ≤ 2 metastasis (83.3%), had single organ involvement (90.3%), and staged using flouro-deoxyglucose positron emission tomography (FDG-PET/CT) (76%). The median fraction and total radiation doses were 10 Gy (range: 6-34 Gy) and 50 Gy (range: 8-64 Gy), respectively, delivered in a median of 4 fractions (range: 1-8). The median follow-up time for the entire cohort was 30.7 months (interquartile range: 27.0-34.3 months). The 3‑year OS, PFS, and LC rates were 64.0%, 42.3%, and 72.7%, respectively. The 3‑year LC rate was significantly higher in patients receiving BED ≥ 100 Gy than those receiving BED < 100 Gy (76.0% vs. 67.3%; p = 0.04). The 3‑year PFS and OS rates were higher in patients receiving BED ≥ 100 Gy than those receiving BED < 100 Gy (33.2% vs. 25.2%; p = 0.03; 53.7% vs. 44.8%; p = 0.02). Single metastasis and complete response after SBRT were independent prognostic factors for survival in multivariable analysis.
In this multi-center study, we demonstrated that SBRT is an effective treatment option of metastatic lesions in oligometastatic CRC patients by providing promising LC rates. Higher SBRT doses beyond BED ≥ 100 Gy were associated with improved LC and survival. LC of treated lesion and lower tumor burden after SBRT were associated with better outcomes.
探讨立体定向体部放疗（SBRT）治疗颅外寡转移结直肠癌（CRC）患者的治疗效果。
回顾性分析19家癌症机构388例颅外寡转移CRC（≤5个病灶）患者及463个接受SBRT治疗的病灶的临床资料。在单变量和多变量分析中评估预测总生存期（OS）、无进展生存期（PFS）和局部控制（LC）的预后因素。
中位年龄为62岁（范围29 - 92岁）。大多数患者（90.5%）对其原发性肿瘤接受了手术和全身治疗，有≤2处转移（83.3%），单个器官受累（90.3%），并采用氟脱氧葡萄糖正电子发射断层扫描（FDG - PET/CT）进行分期（76%）。中位分次剂量和总放射剂量分别为10 Gy（范围：6 - 34 Gy）和50 Gy（范围：8 - 64 Gy），中位分4次给予（范围：1 - 8次）。整个队列的中位随访时间为30.7个月（四分位间距：27.0 - 34.3个月）。3年OS、PFS和LC率分别为64.0%、42.3%和72.7%。接受生物等效剂量（BED）≥100 Gy的患者3年LC率显著高于接受BED＜100 Gy的患者（76.0%对67.3%；p = 0.04）。接受BED≥100 Gy的患者3年PFS和OS率高于接受BED＜100 Gy的患者（33.2%对25.2%；p = 0.03；53.7%对44.8%；p = 0.02）。单处转移和SBRT后完全缓解是多变量分析中生存的独立预后因素。
在这项多中心研究中，我们证明SBRT通过提供有前景的LC率，是寡转移CRC患者转移病灶的有效治疗选择。BED≥100 Gy以上的更高SBRT剂量与改善的LC和生存率相关。治疗病灶的LC以及SBRT后较低的肿瘤负荷与更好的预后相关。
