Superior outcomes of nodal metastases compared to visceral sites in oligometastatic colorectal cancer treated with stereotactic ablative radiotherapy

O'Cathail, S. M. , Smith, T., Owens, R., Zeniou, A., Tsang, Y., Holyoake, D. L.P., Murray, L., Harrison, M. and Hawkins, M. A. (2020) Superior outcomes of nodal metastases compared to visceral sites in oligometastatic colorectal cancer treated with stereotactic ablative radiotherapy. Radiotherapy and Oncology, 151, pp. 280-286. (doi: 10.1016/j.radonc.2020.08.012) (PMID:32866563) (PMCID:PMC7689579)

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Abstract

BACKGROUND:Stereotactic ablative radiotherapy (SBRT) is a radical option for oligometastatic colorectal cancer (CRC) patients, but most data relate to visceral metastases. METHODS:A prospective, multi-centre database of CRC patients treated with SBRT was interrogated. Inclusion criteria were ECOG PS 0-2, ≤ 3 sites of disease, a disease free interval of > 6 months unless synchronous liver metastases. Primary endpoints were local control (LC), progression free survival (PFS) and overall survival (OS). RESULTS:163 patients (172 metastases) were analysed. The median FU was 16 months (IQR 12.2 - 22.85). The LC at 1 year was 83.8% (CI 76.4% - 91.9%) with a PFS of 55% (CI 47% - 64.7%) respectively. LC at 1 year was 90% (CI 83% - 99%) for nodal metastases (NM), 75% (63% - 90%) for visceral metastases (VM). NM had improved median PFS (9 vs 19 months) [HR 0.6, CI 0.38 - 0.94, p = 0.032] and median OS (32 months vs not reached) [HR 0.28, CI 0.18 - 0.7, p = 0.0062] than VM, regardless of whether the NM were located inside or outside the pelvis. On multivariate analysis, NM and ECOG PS 0 were significant good prognostic factors. An exploratory analysis suggests KRAS WT is also a good prognostic factor. CONCLUSION:Nodal site is an important prognostic determinant of SBRT that should incorporated into patient selection. We hypothesise this may have an immunoediting basis.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:O'Cathail, Dr Sean
Authors: O'Cathail, S. M., Smith, T., Owens, R., Zeniou, A., Tsang, Y., Holyoake, D. L.P., Murray, L., Harrison, M., and Hawkins, M. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Radiotherapy and Oncology
Publisher:Elsevier
ISSN:0167-8140
ISSN (Online):1879-0887
Published Online:29 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Radiotherapy and Oncology 151: 280-286
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174115CRUK Centre RenewalOwen SansomCancer Research UK (CRUK)C7932/A25142CS - Beatson Institute for Cancer Research