Li Sixuan, Dong Dezuo, Zheng Xuan, Wang Hongzhi, Wang Kun, Xing Baocai, Wang Weihu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Hepato-Biliary-Pancreatic Surgery I, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Curr Oncol. 2025 Jun 12;32(6):347. doi: 10.3390/curroncol32060347.
Given the promising outcomes of stereotactic body radiation therapy (SBRT) in treating colorectal cancer liver metastases (CRLMs), we proposed an innovative strategy combining surgery with planned liver SBRT for CRLMs. This retrospective study included patients who underwent curative-intent surgery combined with planned liver SBRT from July 2019 to October 2023. Planned liver SBRT was delivered to residual unresectable and unablatable lesions with maximum diameters of ≤5 cm. Outcomes included local failure (LF), intrahepatic recurrence-free survival (IHRFS), extrahepatic recurrence-free survival (EHRFS), progression-free survival (PFS), overall survival (OS), and radiation-related adverse events. A total of 69 patients were included. The 1-, and 2-year cumulative incidence rates of LF after SBRT were 7.7%, and 9.6%, respectively. The median PFS was 6.2 months, and the median OS was 45.8 months. Multivariate analysis identified RAS/BRAF mutations, extrahepatic metastases excluding lung involvement, and higher CEA as independent predictors of poorer OS. Intrahepatic recurrence was the predominant pattern of first disease progression after combination treatment. Acute grade 1-2 radiation-related adverse events occurred in 56.5% of patients, while grade 3 toxicities were reported in 4.3%. This approach offers favorable long-term outcomes, suggesting its potential to broaden the indications for curative-intent local treatments in CRLMs.
鉴于立体定向体部放射治疗（SBRT）在治疗结直肠癌肝转移（CRLMs）方面取得了令人鼓舞的成果，我们提出了一种将手术与计划性肝脏SBRT相结合治疗CRLMs的创新策略。这项回顾性研究纳入了2019年7月至2023年10月期间接受根治性手术联合计划性肝脏SBRT的患者。计划性肝脏SBRT用于治疗最大直径≤5 cm的残留不可切除且不可消融的病灶。观察指标包括局部失败（LF）、肝内无复发生存期（IHRFS）、肝外无复发生存期（EHRFS）、无进展生存期（PFS）、总生存期（OS）以及与放疗相关的不良事件。共纳入69例患者。SBRT后1年和2年的LF累积发生率分别为7.7%和9.6%。中位PFS为6.2个月，中位OS为45.8个月。多因素分析确定RAS/BRAF突变、不包括肺转移的肝外转移以及较高的癌胚抗原（CEA）水平是OS较差的独立预测因素。肝内复发是联合治疗后首次疾病进展的主要模式。56.5%的患者发生了1-2级急性放疗相关不良事件，而3级毒性反应的报告率为4.3%。这种方法提供了良好的长期疗效，表明其有可能扩大CRLMs根治性局部治疗的适应证。
