Abstract
BackgroundSurgical intervention and radiation therapy are common approaches for pulmonary metastasectomy. The role of minimally invasive techniques in pulmonary metastases remains unclear. Frameless single robotic radiosurgery [CyberKnife (CK); Accuray Incorporated, Sunnyvale, CA] of pulmonary metastases in colorectal cancer (CRC) patients offers high precision local radiation therapy.MethodsWe analyzed the efficacy and safety of CK treatment for lung metastases in CRC in 34 patients and a total of 45 lesions. The primary endpoint was local control (LC); secondary endpoints were progression-free survival (PFS), overall survival (OS), distant control (DC), and safety-relevant events.ResultsOf the treated lesions, 34/45 (77.8%) decreased in size or remained unchanged [complete response (CR), partial response (PR), stable disease (SD)]; 8/45 (17.8%) lesions increased in size [progressive disease (PD)] and 2/45 (4.4%) lesions were not evaluable. Local progression was shown in 2 lesions (4.4 %). The median PFS period was six months. In a median follow-up time of 19.4 months, medium OS was 19.9 months (range: 3-61 months). Distant recurrence was observed in 21/34 patients (61.8 %). Intrapulmonary progression occurred in six patients. In 4/45 cases, fiducial placement led to a pneumothorax; three out of four patients needed chest tube insertion. No radiation-associated side effects were reported in 57.8% of patients. In 10/45 cases (22.2%), patients suffered asymptomatic radiographic changes; 7/45 cases (15.6%) reported a late onset of radiation-associated side effects. Maximal radiation-associated side effects reached the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) Grade 1.ConclusionCK treatment of pulmonary metastases is safe and well-tolerated. For metastatic colorectal cancer (mCRC) patients with pulmonary metastases and not eligible for surgery, CK radiation offers a valuable treatment option.
Highlights
About 50-60% of all patients with colorectal cancer (CRC) develop metastatic disease [metastatic colorectal cancer] [1]
34/45 (77.8%) decreased in size or remained unchanged [complete response (CR), partial response (PR), stable disease (SD)]; 8/45 (17.8%) lesions increased in size [progressive disease (PD)] and 2/45 (4.4%) lesions were not evaluable
In terms of local control (LC), 35/45 treated lesions (77.8%) decreased in size or remained unchanged [complete response (CR), partial response (PR), stable disease (SD)], 8/45 (17.8%) lesions increased in size [progressive disease (PD)], and 2/45 (4.4%) lesions were not evaluable due to missing follow-up scans
Summary
About 50-60% of all patients with colorectal cancer (CRC) develop metastatic disease [metastatic colorectal cancer (mCRC)] [1]. In 8-10% of CRC patients, pulmonary metastases occur after previous liver metastases [5]. The development of novel therapeutic regimens, agents, and combinations have led to higher response rates and longer overall survival [6,7,8]. 5-year survival rates of up to 40% after resection have been reported [9,10]. Since not all patients with pulmonary metastases are eligible for surgical treatment and since techniques are heterogeneous, new treatment options are needed [1,5,11]. Surgical intervention and radiation therapy are common approaches for pulmonary metastasectomy. The role of minimally invasive techniques in pulmonary metastases remains unclear. Frameless single robotic radiosurgery [CyberKnife (CK); Accuray Incorporated, Sunnyvale, CA] of pulmonary metastases in colorectal cancer (CRC) patients offers high precision local radiation therapy
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