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Showing content from https://pubmed.ncbi.nlm.nih.gov/32030236/ below:

A systematic review and meta-analysis of stereotactic body radiation therapy for colorectal pulmonary metastases

Affiliations

• ¹ Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
• ² Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
• ³ Chris O'Brien Lifehouse Hospital, Sydney, Australia.
• ⁴ Department of Medicine, Cornell University, New York, USA.
• ⁵ Collaborative Research Group, Macquarie University, Sydney, Australia.
• ⁶ Department of Anaesthesia, Westmead Hospital, Sydney, Australia.
• ⁷ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.

• PMID: 32030236
• PMCID: PMC6988072
• DOI: 10.21037/jtd.2019.12.12

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Christopher Cao et al. J Thorac Dis. 2019 Dec.

• ¹ Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
• ² Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
• ³ Chris O'Brien Lifehouse Hospital, Sydney, Australia.
• ⁴ Department of Medicine, Cornell University, New York, USA.
• ⁵ Collaborative Research Group, Macquarie University, Sydney, Australia.
• ⁶ Department of Anaesthesia, Westmead Hospital, Sydney, Australia.
• ⁷ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.

• PMID: 32030236
• PMCID: PMC6988072
• DOI: 10.21037/jtd.2019.12.12

Item in Clipboard

Background: There is growing evidence to support the hypothesis that radical treatment of pulmonary oligometastatic disease with stereotactic body radiation therapy (SBRT) can improve oncological outcomes. However, some reports suggest colorectal cancer (CRC) pulmonary metastases are associated with radioresistance. The present systematic review aimed to assess the local control (LC), overall survival (OS), and progression-free survival (PFS) of patients with CRC pulmonary metastases treated by SBRT. Secondary outcomes included assessment of peri-procedural complications and identification of prognostic factors on LC.

Methods: Electronic databases were systematically searched from their dates of inception using predefined criteria. Summative statistical analysis was performed for patients with CRC pulmonary metastases, and comparative meta-analysis was performed for patients with CRC versus non-CRC pulmonary metastases.

Results: Using predefined criteria, 18 relevant studies were identified from the existing literature. LC for CRC pulmonary metastases treated by SBRT at 1-, 2-, and 3-year were estimated to be 81%, 66%, and 60%, respectively. OS and PFS at 3-year were 52% and 13%, respectively. Patients with CRC pulmonary metastases were associated with significantly lower LC compared to non-CRC pulmonary metastases [HR, 2.93; 95% confidence interval (CI), 1.93-4.45; P<0.00001], but higher OS (HR, 0.61; 95% CI, 0.45-0.82; P=0.001). There were no reported periprocedural mortalities and low incidences of periprocedural morbidities.

Conclusions: These findings may have implications for patient and treatment selection, dose fractionation, and support the hypothesis that CRC pulmonary metastases may require higher biological effective doses while respecting normal tissue constraints when treated with SBRT.

Keywords: Stereotactic body radiation therapy (SBRT); colorectal cancer (CRC); meta-analysis; pulmonary metastasis; systematic review.

2019 Journal of Thoracic Disease. All rights reserved.

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Conflicts of Interest: The authors have no conflicts of interest to declare.

PRISMA flow chart summarizing the…

PRISMA flow chart summarizing the literature search strategy in the systematic review on…

PRISMA flow chart summarizing the literature search strategy in the systematic review on stereotactic body radiation therapy for patients with colorectal and non-colorectal pulmonary metastases.

Local control. (A) Cumulative Kaplan-Meier…

Local control. (A) Cumulative Kaplan-Meier graph demonstrating estimated local control of colorectal pulmonary…

Local control. (A) Cumulative Kaplan-Meier graph demonstrating estimated local control of colorectal pulmonary metastases after stereotactic body radiation therapy. Shaded region indicates 95% confidence interval (CI). (B) Forest plot of the odds ratio (OR) of local control in patients with colorectal pulmonary metastases versus non-colorectal pulmonary metastases after stereotactic body radiation therapy. The estimate of the OR of each study corresponds to the middle of the squares and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number randomized are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary OR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.

Local control. (A) Cumulative Kaplan-Meier…

Local control. (A) Cumulative Kaplan-Meier graph demonstrating local control of colorectal pulmonary metastases…

Local control. (A) Cumulative Kaplan-Meier graph demonstrating local control of colorectal pulmonary metastases versus non-colorectal pulmonary metastases after stereotactic body radiation therapy. Shaded regions represent 95% confidence interval (CI). (B) Forest plot of the odds ratio (OR) of local control in patients with colorectal pulmonary metastases versus non-colorectal pulmonary metastases after stereotactic body radiation therapy. The estimate of the OR of each study corresponds to the middle of the squares and the horizontal line shows the 95% CI. On each line, the numbers of events as a fraction of the total number randomized are shown for both treatment groups. For each subgroup, the sum of the statistics, along with the summary OR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics.

Overall survival. (A) Cumulative Kaplan-Meier…

Overall survival. (A) Cumulative Kaplan-Meier graph demonstrating overall survival of patients with colorectal…

Overall survival. (A) Cumulative Kaplan-Meier graph demonstrating overall survival of patients with colorectal pulmonary metastases after stereotactic body radiation therapy. (B) Cumulative Kaplan-Meier graph demonstrating overall survival of patients with colorectal pulmonary metastases versus non-colorectal pulmonary metastases after stereotactic body radiation therapy. Shaded regions indicate 95% confidence interval.

Progression-free survival. Shaded region indicates…

Progression-free survival. Shaded region indicates 95% confidence interval.

Progression-free survival. Shaded region indicates 95% confidence interval.

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