The role of stereotactic body radiation therapy in oligometastatic colorectal cancer

Abstract

Rationale:Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1-year overall survival rate does not exceed 25%.Patient concerns:A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response.Interventions:After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day.Outcomes:Patient-reported outcome was characterized by a progression-free survival of approximately 3 years.Lessons:in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment.

Prognostic values of 18F-FDG PET/CT metabolic parameters and clinical figures in locally advanced pancreatic cancer underwent chemotherapy combined with stereotactic body radiation therapy

“…The 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography-computed tomography (PET/CT) has been widely used in the diagnosis, staging and therapeutic evaluation of various malignancies. [16,17] Also, the prognostic prediction value in PDAC was reported by several researchers. [18–20] For resected PDAC patients, 18 F-FDG PET/CT metabolic parameters maximum standardized uptake values (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were illustrated to strongly correlate with OS and progression-free survival (PFS).…”

We need to bring R0 < 1 to treat cancer too

“…SBRT with regorafenib. An mCRC patient with liver metastases taking regorafenib who also received SBRT experienced a durable progression-free survival over 3 years [6]. SBRT monotherapy.…”

Effect of Synchronous Versus Sequential Regimens on the Pharmacokinetics and Biodistribution of Regorafenib with Irradiation

“…Nevertheless, the optimal timing, duration, and dosing of regorafenib when used in combination with RT or SBRT remain unknown. Roberto et al [ 15 ] reported a man affected by metastatic colorectal cancer (mCRC) who was treated with regorafenib combined with multiple fractions of SBRT with 54 Gy, achieving a durable response without severe toxicities. Gatto et al [ 33 ] also reported a patient affected by metastatic gastrointestinal stromal tumor who was treated with RT (34 Gy in 14 fractions) combined with regorafenib (160 mg/day), achieving an objective response.…”

“…Recently, a patient was reported to have developed transverse myelopathy from regorafenib two years after receiving SBRT for metastatic liver lesions [ 14 ]. However, a colon cancer patient who received regorafenib and concurrent SBRT for an oligometastatic lung nodule showed an impressive response [ 15 ]. The treatment or toxicities of regorafenib with RT have different expressions in the concurrent or sequential regimen.…”