Long-term outcome of Stereotactic Body Radiation Therapy for patient with unresectable liver metastases from colorectal cancer

• Published in: Cancer radiothérapie 2021-06, Vol.25 (4), p.350-357
• Main Authors: Py, J.F., Salleron, J., Courrech, F., Beckendorf, V., Croisé-Laurent, V., Peiffert, D., Vogin, G., Dietmann, A.S.
• Format: Article
• Language: English
• Subjects: Cancer colorectal; Colorectal cancer; Cyber-couteau; Cyberknife; Dose fractionation; Fractionnement des doses; Liver metastases; Métastases hépatiques; Radiothérapie corporelle stéréotaxique; Stereotactic body radiation therapy; Tolerance; Tolérance
• ISSN: 1278-3218; 1769-6658
• DOI: 10.1016/j.canrad.2021.01.004

To investigate clinical outcome and predicting factors of local failures in patients with colorectal cancer treated for unresectable liver metastases with stereotactic body radiation therapy (SBRT). We restrospectively reviewed the medical records of 67 patients treated with the Cyberknife SBRT system for 99 hepatic metastases between January 2007 and December 2015 in our center. In total, 37.5 to 54.0Gy in 3 to 5 fractions were prescribed to the 80% isodose line. Local control (LC), intrahepatic progression incidence, Progression-Free Survival (PFS), Overall Survival (OS) and toxicity were evaluated. The median follow-up was 47 months (IQR, 28–59 months). The median OS was 53 months, the 2-year OS and PFS rates were 81.4% and 54.0%. The 1- and 2-year LC rates were 86.6% and 72.4%. In the multivariate analysis, the degree of differentiation was the only prognostic factor for LC (HR 0.31, 95% CI, 0.10–0.98, P=0.046). Margin expansion>5mm was not associated with a better LC (HR 0.72, 95% CI, 0.38–1.37, P=0.317). Performans Status≥2 (HR 3.27, 95% CI, 1.07–9.98, P=0.038), chemotherapy for metastases before SBRT (HR 0.36, 95% CI, 0.18–0.75, P=0.006) and regional lymph node at diagnosis (HR 2.19, 95% CI, 1.09–4.43, P=0.029) were independent prognostic factors for OS. We report 2 cases of grade≥3 toxicity (3.0%) – one grade 3 acute nausea and one grade 3 late gastric ulcer. Stereotactic body radiation therapy is an effective and well-tolerated treatment that allow high LC for liver metastases from colorectal cancer during the first two years. A prescription dose of 45Gy in 3 fractions to the 80% isodose line with a risk adapted schedule to respect Organ At Risk constraints allows a low rate of toxicity. Évaluer les résultats cliniques et les facteurs prédictifs de récidive locale des patients traités pour des métastases non résécables de cancer colorectal par par irradiation stéréotaxique par Cyberknife®. Nous rapportons rétrospectivement les données de 67 patients traités par Cyberknife® pour 99 métastases hépatiques entre janvier 2007 et décembre 2015 dans notre centre. Des doses de prescription de 37,5 à 54Gy en trois à cinq fractions ont été prescrites sur l’isodose 80 %. Les taux de contrôle local, de progression intrahépatiques, de survie sans progression, de survie globale et la toxicité sont rapportés. Le suivi médian était de 47 mois (IQR, 28–59 mois). La survie globale médiane était de 53 mois, les probabilités de survies globale et sans progression à 2