Integration of stereotactic radiotherapy in the treatment of metastatic colorectal cancer patients: A real practice study with long-term outcome and prognostic factors

// Alessandro Ottaiano 1, * , Valerio Scotti 2, * , Chiara De Divitiis 3 , Monica Capozzi 3 , Carmen Romano 3 , Antonino Cassata 3 , Rossana Casaretti 3 , Lucrezia Silvestro 3 , Anna Nappi 3 , Valeria Vicario 3 , Alfonso De Stefano 3 , Salvatore Tafuto 3 , Massimiliano Berretta 4 , Guglielmo Nasti 1 and Antonio Avallone 3 1 Department of Abdominal Oncology, SSD–Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori di Napoli G. Pascale IRCCS, National Cancer Institute, 80131, Naples, Italy 2 San Rossore Clinic, Viale delle Cascine, 56122, Pisa, Italy 3 Department of Abdominal Oncology, Experimental Clinical Oncology, Istituto Nazionale Tumori di Napoli G. Pascale IRCCS, National Cancer Institute, 80131, Naples, Italy 4 Department of Medical Oncology, CRO Aviano, National Cancer Institute, 33081, Aviano, Italy * These authors have contributed equally to this work Correspondence to: Guglielmo Nasti, email: g.nasti@istitutotumori.na.it , ale.otto@libero.it Keywords: colorectal cancer; radiation therapy; chemotherapy; metastatic colorectal cancer Received: April 26, 2018      Accepted: June 23, 2018      Published: October 16, 2018 ABSTRACT Background: There are very few clinical or prognostic studies on the role of SRT (Stereotactic Radiation Therapy) in the continuum of care of metastatic colorectal cancer (mCRC) patients. Patients and methods: Patients affected by oligo-mCRC were treated with SRT before or after front-line standard treatments. SRT was delivered according to a risk-adapted protocol. Total body CT (Computed Tomography) scan was done before therapy and every three months thereafter. The radiologic responses to therapy were evaluated by RECIST (Response Evaluation Criteria In Solid Tumors). FDG-PET (FluoroDeoxyGlucose - Positron Emission Tomography) was done before and after SRT; metabolic responses were evaluated by using the EORTC (European Organization for Research and Treatment of Cancer) criteria. The Kaplan-Meier product limit method was applied to graph Overall Survival (OS) and Progression-Free Survival (PFS). Results: Forty-seven patients were included. Twenty-one patients had disease limited to lungs, 9 to lung and liver, 7 only to liver, 10 to multiple sites. The median prescription SRT dose was 60 Gy per organ in 3 fractions (median biological effective dose of 180 Gy). The reduction of delta SUVmax (maximum Standardized Uptake Value) correlated with the local control (p<0.001) and two-years survival (p=0.003). At univariate analysis, localization of primary tumor, site of metastases, KRAS (Kirsten RAt Sarcoma) oncogene mutational status, response to first-line chemotherapy, response to SRT and number of treated lesions predicted both PFS and OS. Discussion: This real practice experience suggests that further studies are needed to analyze the promising role of SRT in the multidisciplinary management of mCRC.