Cisek Paweł, Bilski Mateusz, Ponikowska Julia, Wojtyna Ewa, Fijuth Jacek, Kuncman Łukasz
Department of Brachytherapy, Saint John's Cancer Center, Lublin, Poland.
Department of Radiotherapy, Medical University of Lublin, Lublin, Poland.
Clin Exp Metastasis. 2025 May 12;42(3):29. doi: 10.1007/s10585-025-10348-z.
Colorectal cancer (CRC) often leads to liver metastases, which may be resistant to systemic therapy. This study assessed outcomes and toxicity of computed tomography (CT) guided high-dose-rate (HDR) brachytherapy (BRT) in oligopersistent liver metastases from CRC. The study included patients with liver metastases classified as EORTC/ESTRO-defined induced oligopersistence after multiple systemic therapy lines. Up to four persistent liver metastases per patient were treated with CT-guided brachytherapy (CT-BRT). Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The analysis focused on overall survival (OS), progression-free survival (PFS), tumor burden score (TBS), and the prognostic value of changes in metastasis size. Sixty-eight CRC patients were enrolled. During a median follow-up of 17 months, the median OS was 16 months, and the median PFS was 13 months. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 7%, 35%, 44%, and 6% of patients, respectively. Patients with an objective response (ORR) of 42% had longer OS and PFS than those without it. OS was affected by lymph node metastases and metastasis size reduction, while PFS was additionally influenced by the administered dose. Multivariate analysis showed OS was linked to lymph node metastases (p = 0.001) and ORR (p = 0.004), and PFS to tumor burden score (TBS) difference (p = 0.017) and post-CT-BRT single metastasis size (p = 0.026). CT-BRT for CRC oligopersistent liver metastases is effective, improving PFS and OS, with TBS difference identified as a key response parameter for future strategies.
结直肠癌（CRC）常导致肝转移，而肝转移可能对全身治疗耐药。本研究评估了计算机断层扫描（CT）引导下高剂量率（HDR）近距离放射治疗（BRT）对CRC寡持续性肝转移的疗效和毒性。该研究纳入了经多线全身治疗后被EORTC/ESTRO定义为诱导性寡持续性的肝转移患者。每位患者最多四个持续性肝转移灶接受CT引导下近距离放射治疗（CT-BRT）。使用实体瘤疗效评价标准（RECIST 1.1）评估治疗反应。分析重点为总生存期（OS）、无进展生存期（PFS）、肿瘤负荷评分（TBS）以及转移灶大小变化的预后价值。68例CRC患者入组。在中位随访17个月期间，中位OS为16个月，中位PFS为13个月。分别有7%、35%、44%和6%的患者观察到完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）。客观缓解率（ORR）为42%的患者的OS和PFS长于无客观缓解的患者。OS受淋巴结转移和转移灶大小缩小影响，而PFS还受给药剂量影响。多变量分析显示，OS与淋巴结转移（p = 0.001）和ORR（p = 0.004）相关，PFS与肿瘤负荷评分（TBS）差异（p = 0.017）和CT-BRT后单个转移灶大小（p = 0.026）相关。CT-BRT治疗CRC寡持续性肝转移有效，可改善PFS和OS，TBS差异被确定为未来策略的关键反应参数。
