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SU_2_2012 - Long-Term Survival and Local Control Outcomes in Oligometastatic Colorectal Cancer Treated with Liver Stereotactic Body Radiation Therapy Long-Term Survival and Local Control Outcomes in Oligometastatic Colorectal Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Long-Term Survival and Local Control Outcomes in Oligometastatic Colorectal Cancer Treated with Liver Stereotactic Body Radiation Therapy Long-Term Survival and Local Control Outcomes in Oligometastatic Colorectal Cancer
J. Hinton1, J. O. Galle2, D. Long2, C. Deig3, F. M. Kong2, M. Maluccio4, S. Shahda5, B. H. O'Neil6, and S. G. Ellsworth7; 1Indiana University Department of Radiation Oncology, Indianapolis, IN, 2Indiana University Radiation Oncology, Indianapolis, IN, 3The Colorado Health Foundation, Denver, CO, 4Indiana University Department of Surgery, indianapolis, IN, 5Indiana University School of Medicine, Indianapolis, IN, 6Indiana University, Simon Cancer Center, Indianapolis, IN, 7Indiana University, Indianapolis, IN

Purpose/Objective(s): The purpose of the present study was to evaluate clinical outcomes following stereotactic body radiation therapy (SBRT) in patients with liver metastases (LM) due to colorectal cancer (CRC).

Materials/Methods: This was a single-institution retrospective study of patients included in a prospectively maintained institutional database. Outcome endpoints included overall survival (OS), local control (LC), progression-free survival (PFS), and extra- and intra-hepatic progression-free survival (EHPFS/IHPFS). Eligible patients had LM due to CRC, were treated with SBRT between 2007-2017, and had at least 3 months of follow up. We identified 55 patients that met these criteria; 13/55 (24%) of patients had prior partial hepatectomy. Median number of chemotherapy regimens prior to SBRT was 1 (range 0-3). The majority of patients (81.6%) had a solitary liver metastasis­­; 2 had extrahepatic disease at the time of SBRT. The maximum number of treated LM was 3. Median SBRT dose was 54 Gy (range 32-60 Gy) in 3 fractions (range 3-5), and median BED10 was 151.2 Gy. Median tumor diameter was 2.8 cm (range 0.4-5.6). All survival times were calculated from the start date of SBRT. Kaplan-Meier curves were used to estimate actuarial survival times, and Cox regression was used for multivariable analysis (MVA) of predictors of overall survival.

Results: At a median follow up of 44.5 mos (range 3-96), 24/55 patients (43.6%) of patients have died. Estimated median OS was not reached; estimated mean OS was 61.7 months (95% CI 51.7-71.7), and actuarial 5-year OS estimate was 21%. Median PFS was 13.0 months (95% CI 2.6-23.4); median IHPFS was 26 months (95% CI 15.4-36.4), longer than the estimated median EHPFS of 18 months (95% CI 9.4-26.6). The crude overall rate of hepatic progression was 60.0% (33/55), while the crude rate of extrahepatic progression was 65.4% (36/55). Crude local control was 76% (13/55). Median local control time was significantly longer in patients with higher biologic equivalent dose (BED); median LC was 24 mos vs not reached in patients with BED10 < vs > 150, p = 0.002. OS was also improved in patients with BED10 > 150 (median 32 mos vs not reached and 5-yr OS 29 vs 58% in patients with BED10 < vs > 150, p = 0.03). Cox MVA showed that early local failure was associated with poorer OS (p = 0.004); higher baseline CEA at the time of treatment was also associated with a trend towards worse OS (p = 0.063).

Conclusion: SBRT is very effective in the management of hepatic oligometastases and was associated with an estimated mean OS of over 5 years in selected patients. In this series, 56% of patients who underwent liver SBRT for oligometastatic CRC remain alive after a median follow up of nearly 4 years (median 44.5 months). Overall LC was excellent and was strongly associated with higher BED. Early local progression was also associated with inferior OS, supporting efforts to achieve as high a BED as possible in SBRT plans for oligometastatic CRC.

Author Disclosure: J. Hinton: None. J.O. Galle: None. D. Long: None. F.(. Kong: Research Grant; Varian, NCI/NIH. Founding President and Board of Director; Sino-American Network for Therapeutic Radiation On. President 2015; American Association of Women Radiologists (AAWR). President 2012-2013; Association for Chinese Professors. Founding Board Member; Sino-American Network for Therapeutic Radiology. M. Maluccio: None. S.G. Ellsworth: None.

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