A Concise Review of Pelvic Radiation Therapy (RT) for Rectal Cancer with Synchronous Liver Metastases

Abstract

Background and Objective. Colorectal cancer is a major health concern as a very common cancer and a leading cause of cancer-related mortality worldwide. The liver is a very common site of metastatic spread for colorectal cancers, and, while nearly half of the patients develop metastases during the course of their disease, synchronous liver metastases are detected in 15% to 25% of cases. There is no standardized treatment in this setting and no consensus exists on optimal sequencing of multimodality management for rectal cancer with synchronous liver metastases. Methods. Herein, we review the use of pelvic radiation therapy (RT) as part of potentially curative or palliative management of rectal cancer with synchronous liver metastases. Results. There is accumulating evidence on the utility of pelvic RT for facilitating subsequent surgery, improving local tumor control, and achieving palliation of symptoms in patients with stage IV rectal cancer. Introduction of superior imaging capabilities and contemporary RT approaches such as Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) offer improved precision and toxicity profile of radiation delivery in the modern era. Conclusion. Even in the setting of stage IV rectal cancer with synchronous liver metastases, there may be potential for extended survival and cure by aggressive management of primary tumor and metastases in selected patients. Despite lack of consensus on sequencing of treatment modalities, pelvic RT may serve as a critical component of multidisciplinary management. Resectability of primary rectal tumor and liver metastases, patient preferences, comorbidities, symptomatology, and logistical issues should be thoroughly considered in decision making for optimal management of patients.

With versus Without Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival

“…In previous clinical studies of primary tumor radiotherapy for metastatic rectal cancer, radiotherapy doses were generally low. Sager et al reviewed many of studies in which the dose of radiotherapy delivered to primary tumor ranged from 25 to 50 Gy [22]. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the BED of above studies ranged from 37.5 to 53.1 Gy.…”

The effect of primary tumor radiotherapy in patients with Unresectable stage IV Rectal or Rectosigmoid Cancer: a propensity score matching analysis for survival

“…In previous clinical studies on primary tumor radiotherapy for metastatic rectal cancer, the radiotherapy doses were generally low. Sager et al reviewed many studies in which the radiotherapy dose delivered to the primary tumors ranged from 25 to 50 Gy [25]. When the α/β of the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the BED of the above studies ranged from 37.5 to 53.1 Gy.…”

Liver Metastases Pattern in Rectal Cancer: A Real-World Analysis in the SEER Database

“…The data of patient were obtained from the SEER program database between 2010 and 2016. SEER*Stat software (Version 8.3.5, http://seer.cancer.gov/seerstat/download) was used to define rectal Submit your Manuscript | www.austinpublishinggroup.com cancer patients with the inclusion criteria: (1) clear pathological diagnosis; (2) Diagnostic time between 2010 and 2016; (3) The "primary site" labelled as "C20.9-Rectum, NOS"; (4) TNM staging according to the seventh edition of AJCC; (5) Known survival time. An exclusion procedure was then performed to determine cases of rectal cancer with liver metastases.…”