The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases

Klement, Rainer J.; Abbasi-Senger, N.; Adebahr, S.; Alheid, H.; Allgäuer, Michael; Becker, Gerd; Blanck, Oliver; Boda-Heggemann, Judit; Brunner, Thomas; Duma, Marciana-Nona; Eble, Michael J.; Ernst, Iris; Gerum, S.; Habermehl, Daniel; Hass, Peter; Henkenberens, Christoph; Hildebrandt, Guido; Imhoff, Detlef; Kahl, H.; Klass, N. D.; Krempien, Robert; Lewitzki, V.; Lohaus, Fabian; Ostheimer, C.; Papachristofilou, Alexandros; Petersen, Cordula; Rieber, Juliane; Schneider, T.; Schrade, E.; Semrau, R.; Wachter, Stefan De; Wittig, Andrea; Gückenberger, Matthias; Andratschke, Nicolaus

doi:10.1186/s12885-019-5362-5

Cited by 73 publications

(49 citation statements)

References 37 publications

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“…This study is mainly concerned with the prognosis of elderly patients with colorectal cancer after surgery. Radiotherapy may have a greater impact on the prognosis [36][37][38]. In order to avoid this effect, we removed all patients who received radiotherapy at any time.…”

Section: Discussionmentioning

confidence: 99%

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

Wang¹,

Wang²,

Yang³

et al. 2020

World J Surg Onc

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Background: Clinically, when the diagnosis of colorectal cancer is clear, patients are more concerned about their own prognosis survival. Special population with high risk of accidental death, such as elderly patients, is more likely to die due to causes other than tumors. The main purpose of this study is to construct a prediction model of cause-specific death (CSD) in elderly patients using competing-risk approach, so as to help clinicians to predict the probability of CSD in elderly patients with colorectal cancer. Methods: The data were extracted from Surveillance, Epidemiology, and End Results (SEER) database to include ≥ 65-year-old patients with colorectal cancer who had undergone surgical treatment from 2010 to 2016. Using competing-risk methodology, the cumulative incidence function (CIF) of CSD was calculated to select the predictors among 13 variables, and the selected variables were subsequently refined and used for the construction of the proportional subdistribution hazard model. The model was presented in the form of nomogram, and the performance of nomogram was bootstrap validated internally and externally using the concordance index (Cindex). Results: Dataset of 19,789 patients who met the inclusion criteria were eventually selected for analysis. The fiveyear cumulative incidence of CSD was 31.405% (95% confidence interval [CI] 31.402-31.408%). The identified clinically relevant variables in nomogram included marital status, pathological grade, AJCC TNM stage, CEA, perineural invasion, and chemotherapy. The nomogram was shown to have good discrimination after internal validation with a C-index of 0.801 (95% CI 0.795-0.807) as well as external validation with a C-index of 0.759 (95% CI 0.716-0.802). Both the internal and external validation calibration curve indicated good concordance between the predicted and actual outcomes. Conclusion: Using the large sample database and competing-risk analysis, a postoperative prediction model for elderly patients with colorectal cancer was established with satisfactory accuracy. The individualized estimates of CSD outcome for the elderly patients were realized.

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Section: Discussionmentioning

confidence: 99%

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

Wang¹,

Wang²,

Yang³

et al. 2020

World J Surg Onc

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“…After some textual adjustments following round 1, a strong consensus was eventually reached on the contra-indications for partial hepatectomy, thermal ablation and IRE and moderate consensus on SBRT. The lower consensus regarding SBRT to treat CRLM may be a result of the paucity of disease-specific and/or comparative studies with hard oncological endpoints throughout the literature [93][94][95]. However, a fair amount of studies did show promising results regarding toxicity and local control to treat tumors within the liver and the results seem to be improving [18,19,96].…”

Section: Discussionmentioning

confidence: 99%

Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group

Nieuwenhuizen

Puijk

Bemd

et al. 2020

Cancers

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The guidelines for metastatic colorectal cancer crudely state that the best local treatment should be selected from a ‘toolbox’ of techniques according to patient- and treatment-related factors. We created an interdisciplinary, consensus-based algorithm with specific resectability and ablatability criteria for the treatment of colorectal liver metastases (CRLM). To pursue consensus, members of the multidisciplinary COLLISION and COLDFIRE trial expert panel employed the RAND appropriateness method (RAM). Statements regarding patient, disease, tumor and treatment characteristics were categorized as appropriate, equipoise or inappropriate. Patients with ECOG≤2, ASA≤3 and Charlson comorbidity index ≤8 should be considered fit for curative-intent local therapy. When easily resectable and/or ablatable (stage IVa), (neo)adjuvant systemic therapy is not indicated. When requiring major hepatectomy (stage IVb), neo-adjuvant systemic therapy is appropriate for early metachronous disease and to reduce procedural risk. To downstage patients (stage IVc), downsizing induction systemic therapy and/or future remnant augmentation is advised. Disease can only be deemed permanently unsuitable for local therapy if downstaging failed (stage IVd). Liver resection remains the gold standard. Thermal ablation is reserved for unresectable CRLM, deep-seated resectable CRLM and can be considered when patients are in poor health. Irreversible electroporation and stereotactic body radiotherapy can be considered for unresectable perihilar and perivascular CRLM 0-5cm. This consensus document provides per-patient and per-tumor resectability and ablatability criteria for the treatment of CRLM. These criteria are intended to aid tumor board discussions, improve consistency when designing prospective trials and advance intersociety communications. Areas where consensus is lacking warrant future comparative studies.

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“…Whereas current image guidance achieves accurate targeting of most target lesions, metastases located in the upper abdomen and liver are still challenging for cone-beam CT-based or planar X-ray-based treatment delivery systems. This may at least partially explain the worse local control rates observed in liver SBRT compared to lung SBRT (Klement et al, 2019). In particular, MRI-based image guidance solutions are expected to address this challenge, especially when combined with online adaptive radiotherapy (Corradini et al, 2019).…”

Section: Technology To Advance Cancer Care: the Example Of Sbrt For Omentioning

confidence: 99%

Technology‐driven research for radiotherapy innovation

et al. 2020

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Technology has a pivotal role in the continuous development of radiotherapy. The long road toward modern ‘high‐tech’ radiation oncology has been studded with discoveries and technological innovations that resulted from the interaction of various disciplines. In the last decades, a dramatic technology‐driven revolution has hugely improved the capability of accurately and safely delivering complex‐shaped dose distributions. This has contributed to many clinical improvements, such as the successful management of lung cancer and oligometastatic disease through stereotactic body radiotherapy. Technology‐driven research is an active and lively field with promising potential in several domains, including image guidance, adaptive radiotherapy, integration of artificial intelligence, heavy‐particle therapy, and ‘flash’ ultra‐high dose‐rate radiotherapy. The evolution toward personalized Oncology will deeply influence technology‐driven research, aiming to integrate predictive models and omics analyses into fast and efficient solutions to deliver the best treatment for each single patient. Personalized radiation oncology will need affordable technological solutions for middle‐/low‐income countries, as these are expected to experience the highest increase of cancer incidence and mortality. Moreover, technology solutions for automation of commissioning, quality assurance, safety tests, image segmentation, and plan optimization will be required. Although a large fraction of cancer patients receive radiotherapy, this is certainly not reflected in the worldwide budget for radiotherapy research. Differently from the pharmaceutical companies‐driven research, resources for research in radiotherapy are highly limited to equipment vendors, who can, in turn, initiate a limited number of collaborations with academic research centers. Thus, enhancement of investments in technology‐driven radiotherapy research via public funds, national governments, and the European Union would have a crucial societal impact. It would allow for radiotherapy to further strengthen its role as a highly effective and cost‐efficient cancer treatment modality, and it could facilitate a rapid and equalitarian large‐scale transfer of technology to clinic, with direct impact on patient care.

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The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases

Cited by 73 publications

References 37 publications

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

A competing-risk nomogram to predict cause-specific death in elderly patients with colorectal cancer after surgery (especially for colon cancer)

Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group

Technology‐driven research for radiotherapy innovation

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