Stereotactic Body Radiation Therapy Using Three Fractions for Isolated Lung Recurrence from Colorectal Cancer
ABSTRACT To determine the feasibility of stereotactic body radiotherapy (SBRT) using 3 fractions for isolated colorectal lung metastases.
From June 2003 to December 2006, 13 cases of isolated pulmonary metastasis from colorectal cancer were treated by SBRT due to an inoperable state (7 patients), or the patient's refusal to undergo surgical excision (6 patients). All patients underwent chemotherapy for salvage treatment. SBRT doses ranged from 39 to 51 Gy in 3 fractions. Nine patients had a solitary lesion, 3 patients had 2 lesions, and 1 patient had 3 lesions. Median tumor volume for the 18 lesions was 5.9 ml (range 1.6-45 ml).
Follow-up duration was 15-57 months. Three-year overall survival, local control and progression-free survival rates were 64.7, 52.7 and 11.5%, respectively.Univariate analysis showed that total internal target volume was a significant prognostic factor for local control. During the follow-up, 11 of the 13 patients experienced local recurrence, distant metastasis or both. The most frequent site of failure was in a nontargeted lung region. No severe complication was attributed to SBRT.
Our study suggests the potential feasibility of SBRT for selected patients with 1-3 small metastatic nodules. A further larger-scale study is required to define the indications for SBRT in cases with isolated pulmonary metastasis from colorectal cancer.
- SourceAvailable from: Guy A. Storme
[Show abstract] [Hide abstract]
- "Next, it enables delivery of tumoricidal doses of radiation in a minimal number of fractions to small target volumes. In the eradication of CRC liver- and/or lungmetastases, minimal toxicity and sustained LC rates of 53%-100% are reported with the use of SBRT [8,19,20]. However, SBRT requires a careful selection of the metastases on the base of their localization and dimension, as patients with metastases situated in the proximity of hollow viscous organs such as small bowel, esophagus or stomach could experience unacceptable normal tissue toxicity with the delivery of ablative radiation doses by SBRT . "
ABSTRACT: Complete metastasectomy provides a real chance for long-term survival in patients with oligometastatic colorectal cancer (CRC). For inoperable patients, we evaluated in this study intensity-modulated and image-guided radiotherapy (IMRT-IGRT) by helical tomotherapy. Twenty-four CRC patients with ≤ 5 metastases were enrolled, receiving a dose of 50 Gy in fractions of 5 Gy. No limitations concerning dimension or localization of the metastases were imposed. Whole body PET-CT was performed at baseline and 3 months after the initiation of RT to evaluate the metabolic response rate according to PET Response Criteria in Solid Tumors (PERCIST) version 1.0. A total of 53 metastases were treated. Seventeen patients (71%) received previously ≥ 1 line of chemotherapy for metastatic disease, displaying residual (n = 7) or progressive (n = 10) metabolic active oligometastatic disease at time of inclusion. Most common sites were the lung, liver and lymphnodes. One patient (4%) experienced grade 3 dysphagia. Twenty-two patients were evaluated by post-treatment PET-CT. Twelve patients achieved a complete (n = 6) or partial (n = 6) metabolic response, resulting in an overall metabolic response rate of 55%. At a median follow-up of 10 months, 7 patients (29%) are in remission, of which 5 received previous chemotherapy with residual oligometastatic disease at time of inclusion. The actuarial 1-year local control, progression-free survival, and overall survival were 54%, 14% and 78%. Helical tomotherapy delivering 10 fractions of 5 Gy resulted in a metabolic response rate of 55%, and appeared to be attractive as consolidation of inoperable oligometastatic disease after effective chemotherapy. Eudract 2008-008300-40; NCT00807313.Radiation Oncology 03/2012; 7(1):34. DOI:10.1186/1748-717X-7-34 · 2.36 Impact Factor
Article: 6. Borchers JD, III, Yang HJ, Sakamoto GT, Howes GA, Gupta G, Chang SD, Adler JR, Jr.: Cyberknife stereotactic radiosurgical rhizotomy for trigeminal neuralgia: anatomic and morphological considerations. Neurosurgery 64:A91-A95, 2009. 7. Brown WT, Wu X, Fayad F, Fowler JF, Garcia S, Monterroso MI, de la ZA, Schwade JG: Application of Robotic Stereotactic Radiotherapy to Peripheral Stage I Non-small Cell Lung Cancer with Curative Intent. Clin Oncol (R Coll Radiol ) 2009
- [Show abstract] [Hide abstract]
ABSTRACT: The optimal dose of stereotactic body radiotherapy (SBRT) for metastatic lung tumors has not been clarified. Local control rates of metastatic lung tumors treated with SBRT of 48 Gy in four fractions, which is one of the common dose schedules for Stage I primary lung cancer in Japan, were examined. Between 2006 and 2008, 12 metastatic lung tumors (colorectal cancer, 7; others, 5) in 10 patients and 56 lesions of Stage I primary lung cancer (T1, 43; T2, 13) in 52 patients were treated with SBRT of 48 Gy in four fractions at the isocenter. Two-year overall survival rates were 86% for patients with metastatic lung tumors and 96% for patients with Stage I primary lung cancer (P = 0.4773). One- and 2-year local control rates were 48% and 25% for metastatic lung tumors, and 91% and 88% for Stage I primary lung cancer, respectively (P < 0.0001). The local control rates after SBRT of 48 Gy in four fractions were significantly worse in metastatic lung tumors compared with Stage I primary lung cancer. In SBRT, metastatic lung tumors should be clearly differentiated from primary lung cancer and should be given higher doses.Japanese Journal of Clinical Oncology 10/2009; 40(2):125-9. DOI:10.1093/jjco/hyp129 · 1.75 Impact Factor