Radiation therapy for colorectal liver metastasis: The effect of radiation therapy dose and chemotherapy on local control and survival Journal Article
| Authors: | Chen, I.; Jeong, J.; Romesser, P. B.; Hilal, L.; Cuaron, J.; Zinovoy, M.; Hajj, C.; Yang, T. J.; Tsai, J.; Yamada, Y.; Wu, A. J.; White, C.; Fiasconaro, M.; Segal, N. H.; Kemeny, N. E.; Zhang, Z.; Crane, C. H.; Reyngold, M. |
| Article Title: | Radiation therapy for colorectal liver metastasis: The effect of radiation therapy dose and chemotherapy on local control and survival |
| Abstract: | Purpose: Colorectal liver metastases (CLMs) represent a radioresistant histology. We aimed to investigate CLM radiation therapy (RT) outcomes and explore the association with treatment parameters. Methods and Materials: This retrospective analysis of CLM treated with RT at Memorial Sloan Kettering Cancer Center used Kaplan-Meier analysis to estimate freedom from local progression (FFLP), hepatic progression-free, progression-free, and overall survival (OS). Cox proportional hazards regression was used to evaluate association with clinical factors. Dose-response relationship was further evaluated using a mechanistic tumor control probability (TCP) model. Results: Ninety patients with 122 evaluable CLMs treated 2006 to 2019 with a variety of RT fractionation schemes with a median biologically effective dose (α/β = 10; BED10) of 97.9 Gy (range, 43.2-187.5 Gy) were included. Median lesion size was 3.5 cm (0.7-11.8 cm). Eighty-seven patients (97%) received prior systemic therapy, and 73 patients (81%) received prior liver-directed therapy. At a median follow-up of 26.4 months, rates of FFLP and OS were 62% (95% CI, 53%-72%) and 75% (66%-84%) at 1 year and 42% (95% CI, 32%-55%) and 44% (95% CI, 34%-57%) at 2 years, respectively. BED10 below 96 Gy and receipt of ≥3 lines of chemotherapy were associated with worse FFLP (hazard ratio [HR], 2.69; 95% CI, 1.54-4.68; P < .001 and HR, 2.67; 95% CI, 1.50-4.74; P < .001, respectively) and OS (HR, 2.35; 95% CI, 1.35-4.09; P = .002 and HR, 4.70; 95% CI, 2.37-9.31; P < .001) on univariate analyses, which remained significant or marginally significant on multivariate analyses. A mechanistic Tumor Control Probability (TCP) model showed a higher 2-Gy equivalent dose needed for local control in patients who had been exposed to ≥ 3 lines of chemotherapy versus 0 to 2 (250 ± 29 vs 185 ± 77 Gy for 70% TCP). Conclusions: In a large single-institution series of heavily pretreated patients with CLM undergoing liver RT, low BED10 and multiple prior lines of systemic therapy were associated with lower local control and OS. These results support continued dose escalation efforts for patients with CLM. © 2023 The Authors |
| Keywords: | adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; major clinical study; overall survival; ascites; gastrointestinal hemorrhage; systemic therapy; cancer radiotherapy; follow up; antineoplastic agent; progression free survival; radiotherapy dosage; retrospective study; radiation dose fractionation; probability; cancer size; hepatectomy; cancer control; liver abscess; radiofrequency ablation; cholestasis; radiation toxicity; medical history; biloma; colorectal liver metastasis; human; male; female; article; artificial embolization; effective dose (radiation); local progression free survival; radiation dose response |
| Journal Title: | Advances in Radiation Oncology |
| Volume: | 9 |
| Issue: | 2 |
| ISSN: | 2452-1094 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-01-31 |
| Start Page: | 101382 |
| Language: | English |
| DOI: | 10.1016/j.adro.2023.101382 |
| PROVIDER: | scopus |
| PMCID: | PMC10870167 |
| PUBMED: | 38370274 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Marsha Reyngold -- Source: Scopus |
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