Stereotactic body radiation therapy in patients with liver oligometastases from colorectal cancer: a systematic review

The purpose of the systematic review is to summarize the data regarding safety and efficacy of stereotactic body radiation therapy in patients with oligometastases of colorectal cancer to the liver.
Published scientific articles on the topic were identified by searching the databases mEDLInE, Pubmed, EmBASE. The review includes publications reporting on the results of treatment of patients undergoing stereotactic radiation therapy for. The systematic review includes all retrospective and prospective studies found over the past 15 years with at least 10 patients with liver metastases of colorectal origin included and standardized methodology of radiation therapy. We included into the review 20 studies comprising 919 patients. Comparative analysis was complicated because of the absence of control groups in all of the studies. moreover, 16 studies were single-center with heterogeneous groups of patients and various regimens of stereotaxic radiation therapy. Despite this, the researchers achieved 60–100 % rates of one-year local control, 56–100 % one-year overall survival with median overall survival up to 45 months and the number of clinically significant complications less than 10 %.
From our point of view, the results of published studies support the safety and efficacy of stereotactic radiation therapy in patients with colorectal cancer and oligometastatic liver disease. we consider stereotactic body radiation therapy to be one of the local control options in case of careful patient selection and the use of modern radiation therapy options. further randomized controlled trials are needed.

1. Van Cutsem E., Nordlinger B., Adam R. et al. European Colorectal Metastases Treatment Group. Towards a panEuropean consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 2006;42(14):2212–21. DOI: 10.1016/j.ejca.2006.04.012.

2. Adam R., De Gramont A., Figueras J. et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 2012;17:1225–39.

3. Adam R., De Gramont A., Figueras J. et al. Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 2015;41:729–41.

4. Gold J.S., Are C., Kornprat P. et al. Increased use of parenchymal-sparing surgery for bilateral liver metastases fromcolorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 2008;247:109–17.

5. Nordlinger B., Van Cutsem E., Rougier P. et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. Eur J Cancer 2007;43:2037–45.

6. Guckenberger M., Lievens Y., Bouma A.B. et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol 2020;21(1):e18–e28. DOI: 10.1016/S1470-2045(19)30718-1.

7. Hoyer M., Roed H., Traberg Hansen A. et al. Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 2006;45(7):823–30. DOI: 10.1080/02841860600904854.

8. Stintzing S., Grothe A., Hendrich S. et al. Percutaneous radiofrequency ablation (RFA) or robotic radiosurgery (RRS) for salvage treatment of colorectal liver metastases. Acta Oncol 2013;52(5):971–7. DOI: 10.3109/0284186X.2013.766362.

9. Ahmed K.A., Caudell J.J., El-Haddad G. et al. Radiosensitivity differences between liver metastases based on primary histology suggests implications for clinical outcomes after stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2016;95(5):1399–404. DOI: 10.1016/j.ijrobp.2016.03.050.

10. Berber B., Ibarra R., Snyder L. et al. Multicentre results of stereotactic body radiotherapy for secondary liver tumours. HPB (Oxford) 2013;15(11):851–7. DOI: 10.1111/hpb.12044.

11. Chang D.T., Swaminath A., Kozak M. et al. Stereotactic body radiotherapy for colorectal liver metastases: a pooled analysis. Cancer 2011;117(17):4060–9. DOI: 10.1002/cncr.25997.

12. Doi H., Uemoto K., Suzuki O. et al. Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer. Oncol Lett 2017;14(1):453–60. DOI: 10.3892/ol.2017.6167.

13. Vernaleone M., Bonomo P., Di Cataldo V. et al. Robotic stereotactic radiotherapy for liver oligometastases from colorectal cancer: a single-center experience. Radiol Med 2019;124(9):870–6. DOI: 10.1007/s11547-019-01042-8.

14. Scorsetti M., Comito T., Tozzi A. et al. Final results of a phase II trial for stereotactic body radiation therapy for patients with inoperable liver metastases from colorectal cancer. J Cancer Res Clin Oncol 2015;141(3):543–53. DOI: 10.1007/s00432-014-1833-x.

15. Van der Pool A.E., Mendez R.A., Wunderink W. et al. Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg 2010;97(3):377–82.

16. Lee M.T., Kim J.J., Dinniwell R. et al. Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol 2009;27(10):1585–91. DOI: 10.1200/JCO.2008.20.0600.

17. Goodman B.D., Mannina E.M., Althouse S.K. et al. Long-term safety and efficacy of stereotactic body radiation therapy for hepatic oligometastases. Pract Radiat Oncol 2016;6(2):86–95. DOI: 10.1016/j.prro.2015.10.011.

18. Stintzing S., Einem J.V., Fueweger C. et al. Long-term survival in patients treated with a robotic radiosurgical device for liver metastases. Cancer Res Treat 2019; 51(1):187–93. DOI: 10.4143/crt.2017.594.

19. Van De Voorde L., Vanneste B., Houben R. et al. Image-guided stereotactic ablative radiotherapy for the liver: a safe and effective treatment. Eur J Surg Oncol 2015;41(2):249–56. DOI: 10.1016/j.ejso.2014.10.053.

20. Vautravers-Dewas C., Dewas S., Bonodeau F. et al. Image-guided robotic stereotactic body radiation therapy for liver metastases: is there a dose response relationship? Int J Radiat Oncol Biol Phys 2011;81(3):e39–47. DOI: 10.1016/j.ijrobp.2010.12.047.

21. Kim H., Gill B., Beriwal S. et al. Costeffectiveness analysis of stereotactic body radiation therapy compared with radiofrequency ablation for inoperable colorectal liver metastases. Int J Radiat Oncol Biol Phys 2016;95(4):1175–83. DOI: 10.1016/j.ijrobp.2016.02.045.

22. Liu E., Stenmark M.H., Schipper M.J. et al. Stereotactic body radiation therapy for primary and metastatic liver tumors. Transl Oncol 2013;6(4):442–6. DOI: 10.1593/tlo.12448.

23. Méndez Romero A., de Man R.A. Stereotactic body radiation therapy for primary and metastatic liver tumors: From technological evolution to improved patient care. Best Pract Res Clin Gastroenterol 2016;30(4):603–16. DOI: 10.1016/j.bpg.2016.06.003.

24. Flamarique S., Campo M., Asín G. et al. Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters. Clin Transl Oncol 2020;22(12):2350–6. DOI: 10.1007/s12094-020-02375-x.

25. Clerici E., Comito T., Franzese C. et al. Role of stereotactic body radiation therapy in the treatment of liver metastases: clinical results and prognostic factors. Strahlenther Onkol 2020;196(4):325–33. DOI: 10.1007/s00066-019-01524-8.

26. D’Avila Leite P., Gaya S., Lanciano R. et al. Stereotactic body radiotherapy (SBRT) for colorectal liver metastasis: Clinical outcomes from the international multi-institutional RSSearch Patient Registry. J Clin Oncol 2019;37(15 Suppl):e15040.

27. Petrelli F., Comito T., Barni S. et al. SBRT for CRC liver metastases. Stereotactic body radiotherapy for colorectal cancer liver metastases: A systematic review. Radiother Oncol 2018;129(3):427–4. DOI: 10.1016/j.radonc.2018.06.035.