Stereotactic Ablative Radiation Therapy as First Local Therapy for Lung Oligometastases From Colorectal Cancer: A Single-Institution Cohort Study

Filippi, Andrea Riccardo; Badellino, Serena; Ceccarelli, Manuela; Guarneri, Alessia; Franco, Pierfrancesco; Monagheddu, Chiara; Spadi, Rosella; Ragona, Riccardo; Racca, Patrizia; Ricardi, Umberto

doi:10.1016/j.ijrobp.2014.10.046

Cited by 64 publications

(55 citation statements)

References 21 publications

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“…Unfortunately this control was not durable as 1-year PFS was only 23.5% and 1-year LFFS was 56.6%. In comparison, 2 other case series of SBRT for CRC lung metastases by Filippi et al 13 This discrepancy between these studies and ours may be partially attributable to stricter patient selection criteria and more potent prescribed dose in these studies compared with ours. Kim and colleagues excluded patients with disease recurrence in <6 months from resection of primary disease, tumors >6 cm or patients with >4 lesions.…”

Section: Survival and Patterns Of Failurecontrasting

confidence: 89%

“…The high rate of distant failure was seen in other studies of SBRT for CRC lung metastases where 84% to 100% of treated patients developed new lesion(s) in areas not treated with SBRT. 7,13 This demonstrates that improvements to systemic therapy are still vital to any efforts to improve prognosis for patients with CRC metastasis.…”

Section: Survival and Patterns Of Failurementioning

confidence: 99%

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Stereotactic Body Radiotherapy for Lung Metastases from Colorectal Cancer

Qiu

Katz

Chowdhry

et al. 2018

American Journal of Clinical Oncology

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Section: Survival and Patterns Of Failurecontrasting

confidence: 89%

Section: Survival and Patterns Of Failurementioning

confidence: 99%

Stereotactic Body Radiotherapy for Lung Metastases from Colorectal Cancer

Qiu

Katz

Chowdhry

et al. 2018

American Journal of Clinical Oncology

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“…Nevertheless, if only a highly selected subset of patients is eligible for pulmonary resection, reintervention results feasible exclusively in an even more restricted patient subset. For these reasons new randomized control trials are needed to determine the true benefits of re-resection, especially because, in this setting, surgery should be compared with alternative treatment regimens [i.e., radiofrequency ablation (RFA), stereotactic ablative radiation therapy (SABR)] (22).…”

Section: Discussionmentioning

confidence: 99%

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Guerrera¹,

Mossetti²,

Ceccarelli³

et al. 2016

J. Thorac. Dis.

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Background: Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance. Methods: This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed.Results: One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44-60%) and 33% (95% CI: 25-42%), respectively. Two-and 5-year survival after re-resection were 79% (95% CI: 63-89%) and 49% (95% CI: 31-65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis. Conclusions: Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases.Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging. randomized trial and the undefined role of metastasectomy remained the unsolved problem in the management of patients with pulmonary metastasis (MTS) of CRC (5).The purpose of the study was to evaluate the efficacy and the feasibility of lung metastasectomy in colorectal cancer (CRC) in our institution. Moreover, we aimed at exploring prognostic factors for survival and evaluating survival pattern in patients submitted to re-resections. MethodsWe included all consecutive patients who underwent lung metastectomy for pulmonary metastases from CRC at Department of Thoracic Surgery, University of Torino, Italy-from 2004 to 2012. Data were retrospective collected from the surgical registry of our Department. Follow-up (FU) data were acquired by routine visits, telephone contacts or from administrative data (outpatient regional registry). FU was completed over July 2014. Our Institutional Review Board approved the study. Inclusion criteria for lung metastasectomy comprised locally controlled primary CRC, no evidence of extra-thoracic lesions excluding hepatic metastases, single or multiple pulmonary nodules suitable for a radical resection. Stage of primary CRC was assigned according to the Union Internationale Contre le Cancer (UICC) staging system. Pre-op...

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“…Overall survival in one study was 39% at 5 years and 58% at 3-years in the second. [58,59] Factors to Consider When Selecting Therapy The availability of thermal ablation and SABR provides additional tools for treating patients with pulmonary metastases. Generally, patients treated in these studies included patients who failed prior therapies, considered non-surgical candidates or who refused surgery.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Expert Consensus Document on Pulmonary Metastasectomy

Handy

Bremner

Crocenzi

et al. 2019

The Annals of Thoracic Surgery

151

172

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When managing nonseminomatous germ cell tumors, contralateral lung abnormalities ≤ 10 mm can be observed if histology of unilateral PM demonstrates complete tumor necrosis. 17. When managing nonseminomatous germ cell tumors, PM is indicated for select patients with limited number of lung abnormalities after first or second-line platin-based chemotherapy suspected of containing viable nonseminomatous cancer and/or malignant transformation of teratoma into non-germ cell cancer. 18. In breast cancer patients, PM can be considered within a MDT construct. Pulmonary metastasectomy literature characteristics Since 1980, greater than 1000 publications addressed pulmonary metastasectomy, without a single randomized controlled trial (RCT). The overwhelming majority is surgical series, usually single institution, and includes single or multiple pathologies. The pool of patients from which metastasectomy patients derive is not reported, allowing no comparative survival analysis. Historical controls are used or metastatic disease survival is assumed to be zero, a contention not supported by the literature. Yet metastasectomy is infrequently performed (1-6.5%) when sizable populations of cancer patients are reported. [1-3] Thus surgical case series manifest inherent selection bias and do not clarify the role of metastasectomy in prolongation of survival or cure. The literature is further hampered by inconsistent or absent description of other local or systemic therapies and variable length of follow up. Finally, the literature fails to distinguish between prognostic (indolent disease which will do well with any or no treatment) or predictive

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Stereotactic Ablative Radiation Therapy as First Local Therapy for Lung Oligometastases From Colorectal Cancer: A Single-Institution Cohort Study

Cited by 64 publications

References 21 publications

Stereotactic Body Radiotherapy for Lung Metastases from Colorectal Cancer

Stereotactic Body Radiotherapy for Lung Metastases from Colorectal Cancer

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Expert Consensus Document on Pulmonary Metastasectomy

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