Abstract
BackgroundThe aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer.MethodsThe analysis is based on pooled data from two retrospective SBRT databases for pulmonary and hepatic metastases from 27 centers from Germany and Switzerland. Only patients with metastases from colorectal cancer were considered to avoid histology as a confounding factor. An illness-death model was employed to model the relationship between LC and OS.ResultsThree hundred eighty-eight patients with 500 metastatic lesions (lung n = 209, liver n = 291) were included and analyzed. Median follow-up time for local recurrence assessment was 12.1 months. Ninety-nine patients with 112 lesions experienced local failure. Seventy-one of these patients died after local failure. Median survival time was 27.9 months in all patients and 25.4 months versus 30.6 months in patients with and without local failure after SBRT. The baseline risk of death after local failure exceeds the baseline risk of death without local failure at 10 months indicating better survival with LC.ConclusionIn CRC patients with lung or liver metastases, our findings suggest improved long-term OS by achieving metastatic disease control using SBRT in patients with a projected OS estimate of > 12 months.
Highlights
The aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer
Tumor volumes were significantly larger in liver compared to lung metastases, and advanced dose calculation algorithms were used significantly more often for planning treatment of the latter
We recently developed a nomogram for oligometastatic lung disease treated with SBRT based on clinical parameters: Karnofsky performance score (KPS), type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus > 1) [38]
Summary
The aim of this analysis was to model the effect of local control (LC) on overall survival (OS) in patients treated with stereotactic body radiotherapy (SBRT) for liver or lung metastases from colorectal cancer. Liver is the most common site of CRC metastasis and patients with liver metastases have been found to have a poor prognosis with significantly reduced overall survival (OS) [2]. Due to technological innovations and based on positive experiences with treating primary non-small cell lung cancer (NSCLC) patients, stereotactic body radiotherapy (SBRT) is increasingly adopted to treat pulmonary and hepatic metastases. Dose prescriptions have been mostly based on the experiences made with primary NSCLC in case of pulmonary metastases or on maximally tolerable doses for organs at risk in case of liver irradiation. This has not yet been studied using sophisticated models of patient outcomes since no sufficient data has been collected so far
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