Role of stereotactic body radiotherapy for oligometastasis from colorectal cancer

Abstract

Systemic chemotherapy has enabled prolongation of survival in patients with stage IV colorectal cancer. This has subsequently increased the relative significance of local therapy for patients with oligometastases because they can be cured by removal of oligometastatic lesions. One of the most frequently reported tumor histologies for oligometastases is colorectal cancer. Resection is the standard therapy in most settings of oligometastases. Recently, studies have shown that stereotactic body radiotherapy (SBRT) may become a treatment option that provides high local control with minimal morbidity. Two-year local control rates following SBRT for hepatic and pulmonary oligometastases are almost over 80% and are even higher for patients treated with high-dose regimens. The indications of SBRT for other metastatic sites or conditions include isolated lymph nodes, spinal and adrenal metastasis, and post-surgical pelvic recurrence. Many retrospective studies have indicated that SBRT for various lesions results in good outcomes with low morbidity, both in the curative and palliative setting. However, few reports with a high level of evidence have indicated the efficacy of SBRT compared to standard therapy. Hereafter, the optimal indication of SBRT needs to be prospectively investigated to obtain convincing evidence.

Keywords: Oligometastasis, Colorectal cancer, Radiation therapy, Stereotactic ablation body radiation therapy, Local therapy

Core tip: Systemic chemotherapy has enabled prolongation of survival in patients with stage IV colorectal cancer. This has subsequently increased the relative significance of local therapy. Resection is the standard therapy in most settings. Recently, stereotactic body radiotherapy (SBRT) provides high local control with minimal morbidity, both in the curative and palliative setting. The indications of SBRT include liver, lung, isolated lymph nodes, spinal and adrenal metastasis, and post-surgical pelvic recurrence. However, few reports with a high level of evidence have indicated the efficacy of SBRT. Hereafter, the optimal indication of SBRT needs to be prospectively investigated to obtain convincing evidence.