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Purpose <p>The standard treatment for oligometastatic colorectal cancer includes systemic therapy, with surgery and metastasis-directed therapy as options. The optimal strategy, especially for repeat oligoprogression (rOP), remains unclear. We report outcomes of liver computer tomography-guided high-dose rate brachytherapy (CT-BRT) in this setting.</p> Methods <p>This retrospective cohort study included colorectal cancer patients with liver-only oligoprogression during systemic therapy, meeting criteria of up to 5 liver metastases, CT-BRT eligibility, and ECOG status ≤ 2. Patients were followed for local response, progression-free survival (PFS), overall survival (OS), and toxicity. Response, according to RECIST 1.1, was initiated 6&#xa0;months post-CT-BRT.</p> Results <p>A total of 262 metastases were treated in 127 patients, with 67.7% receiving third-line or later systemic therapies. One to four liver metastases were found in 29.1%, 42.5%, 21.2%, and 7.1% of patients, respectively, with a median volume of 128&#xa0;cm<sup>3</sup>. A median of 3 applicators was used, with CT-BRT doses of 15&#xa0;Gy, 20&#xa0;Gy, and 25&#xa0;Gy given to 29.9%, 41.7%, and 28.3% of patients. At 6&#xa0;months complete response occurred in 3.1%, progressive disease in 23.6%, partial response in 19.7%, and stable disease in 53.5%. Median PFS was 9&#xa0;months, median OS was 16&#xa0;months, with 1-year and 2-year OS rates of 65% and 16%, respectively. Liver-only metastases and objective response were associated with longer PFS. The G3 toxicity was 4.0%; no events &gt; G3 were reported.</p> Conclusions <p>This largest study documents favorable outcomes of liver CT-BRT for rOP, establishing this method as a viable option in this indication.</p>

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Comprehensive cohort study: computer tomography-guided high-dose rate brachytherapy as metastasis-directed therapy for liver metastases from colorectal cancer in repeat oligoprogression

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月13日

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  • Mateusz Bilski,
  • Katarzyna Korab,
  • Magdalena Orzechowska,
  • Julia Ponikowska,
  • Paweł Cisek,
  • Barbara Alicja Jereczek-Fossa,
  • Jacek Fijuth,
  • Łukasz Kuncman

摘要

Purpose

The standard treatment for oligometastatic colorectal cancer includes systemic therapy, with surgery and metastasis-directed therapy as options. The optimal strategy, especially for repeat oligoprogression (rOP), remains unclear. We report outcomes of liver computer tomography-guided high-dose rate brachytherapy (CT-BRT) in this setting.

Methods

This retrospective cohort study included colorectal cancer patients with liver-only oligoprogression during systemic therapy, meeting criteria of up to 5 liver metastases, CT-BRT eligibility, and ECOG status ≤ 2. Patients were followed for local response, progression-free survival (PFS), overall survival (OS), and toxicity. Response, according to RECIST 1.1, was initiated 6 months post-CT-BRT.

Results

A total of 262 metastases were treated in 127 patients, with 67.7% receiving third-line or later systemic therapies. One to four liver metastases were found in 29.1%, 42.5%, 21.2%, and 7.1% of patients, respectively, with a median volume of 128 cm3. A median of 3 applicators was used, with CT-BRT doses of 15 Gy, 20 Gy, and 25 Gy given to 29.9%, 41.7%, and 28.3% of patients. At 6 months complete response occurred in 3.1%, progressive disease in 23.6%, partial response in 19.7%, and stable disease in 53.5%. Median PFS was 9 months, median OS was 16 months, with 1-year and 2-year OS rates of 65% and 16%, respectively. Liver-only metastases and objective response were associated with longer PFS. The G3 toxicity was 4.0%; no events > G3 were reported.

Conclusions

This largest study documents favorable outcomes of liver CT-BRT for rOP, establishing this method as a viable option in this indication.