바로가기  >

Abstract
Introduction: Some patients with cancer may present with progressive or persistent disease at a limited number of sites following a period of treatment response. We evaluated the safety and effectiveness of metastasis-directed radiotherapy (MRT) for oligoprogressive or oligopersistent disease in patients receiving systemic treatment for metastatic colorectal cancer (mCRC).

Patients and methods: Patients with mCRC who received 5-fluorouracil, leucovorin, and oxaliplatin; 5-fluorouracil, leucovorin, and irinotecan; and/or capecitabine chemotherapy between 2011 and 2020 at a single institution were identified. Then, those who underwent MRT for five or fewer lesion sites while receiving systemic treatment for other metastases were categorized. The primary endpoint was time to change to systemic therapy. Secondary endpoints included MRT-related toxicity, overall survival, and local control.

Results: Among 4157 patients included, 91 (2%) received MRT to limited lesion sites (55 oligoprogressive and 36 oligopersistent) during systemic treatment following a period of treatment response. The median time to change to next-line systemic therapy was 5 months in the overall cohort (measured from the current chemotherapy session) and 9.5 (range, 6.0-40.6) months in the MRT group (measured from the MRT session). No severe toxicity or systemic treatment interruption was observed following MRT. The 1-year local control and overall survival rates were 69% and 99%, respectively.

Conclusion: In patients with oligoprogressive or oligopersistent mCRC, MRT may be performed safely in conjunction with systemic treatment to maximize the benefit of systemic therapy and to prolong the time to change to systemic therapy. Further prospective studies should confirm these findings.

Trial registration: ClinicalTrials.gov NCT03808662 NCT03256981 NCT02756793 NCT03644303.

Affiliations

Jeongshim Lee  1 , Woong Sub Koom  2 , Hwa Kyung Byun  2 , Gowoon Yang  2 , Mi Sun Kim  2 , Eun Jung Park  3 , Joong Bae Ahn  4 , Seung-Hoon Beom  4 , Han Sang Kim  5 , Sang Joon Shin  4 , Kangpyo Kim  2 , Jee Suk Chang  6
1 Department of Radiation Oncology, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea; Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
2 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
3 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
4 Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
5 Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Graduate School of Medical Science, Brain Korea 21 Project, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
6 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Gangnam Severance Hospital, Seoul, Republic of Korea. Electronic address: chnagjeesuk@yuhs.ac.