International Journal of Surgical Oncology / 2019 / Article / Tab 2

Review Article

A Concise Review of Pelvic Radiation Therapy (RT) for Rectal Cancer with Synchronous Liver Metastases

Table 2

Selected series incorporating pelvic RT as part of potentially curative multimodality management of rectal cancer with synchronously detected liver metastases (with or without other distant metastases).

Authors (Reference)Study yearStudy designNumber of patientsDisease statusRT dose and fractionationMedian follow-up (range)Response to RT

Shin et al. [73]2011Retrospective6Stage IV LARC with synchronous distant metastases25 Gy/5 fx16.7 (15.5-23.5) monthsNo local recurrence during follow-up period
R0 resection accomplished in 5 patients (84%)
Salgado et al. [74]2014Retrospective26Stage IV LARC with synchronous distant metastases45 ±5.4 Gy/25-28 fx-1-year OS 95%
2-year OS 70%
Mean survival time 40.5 months
1-year PFS 91%
2-year PFS 36%
Mean PFS time 23.1 months
1-year LC 91%
2-year LC 66%
Yoon et al. [83]2016Retrospective50Stage IV LARC with synchronous distant metastases25 Gy/5 fx22 (9-59) monthsMedian PFS 16 months
2-year PFS 34.8%
2-year OS 73.9%
5-year OS 55.1%
Cho et al. [82]2016Prospective multicenter randomized phase 2 study38Stage IV rectal cancer with synchronous liver metastases45 ±5.4 Gy/25-28 fx-Overall R0 resection rate for both the primary tumor and liver metastases was 77.8% in arm A (induction CapeOx + CapeOx-RT) and 70% in arm B (CapeOx-RT alone)
Median PFS 14.2 months in arm A and 15.1 months in arm B
3-year OS 75% in arm A and 88.8% in arm B
Kim et al. [81]2016Prospective phase 2 study32Stage IV rectal cancer with synchronous liver metastases25 Gy/5 fx-Surgical resection of rectum and liver accomplished in 25 patients (78%)
R0 resection in 20 patients(63%)
Rectal tumor downstaging in 54% of patients
Median OS 38 months
Median PFS 9 months
Bird et al. [80]2017Retrospective78Stage IV rectal cancer with synchronous liver metastases50.4 Gy/28 fx (split course RT)6.2 yearsRadiological complete or partial response for local disease 90%
Radiological complete or partial response for metastatic disease 66%
Median OS in patients having unresectable metastatic disease at baseline 23 (19-28) months
Estimated 3-year OS 62% for the 12 patients treated with radical surgery for both rectum and liver
For patients not receiving rectal surgery, palliative re-irradiation or surgery at a later date needed in only 7%
Fossum et al. [91]2017Retrospective93Stage IV rectal cancer with synchronous distant metastasesMedian 50.4 Gy/28 fx for LCRT
Median 25 Gy/5 fx for SCRT (±intraoperative RT to median dose of 12.5 Gy)
43 (16-67) monthsLR was not observed in patients receiving neoadjuvant RT
12 patients (26%) receiving no RT had LR
Omission of neoadjuvant RT was associated with development of subsequent LR
5-year OS 43.3% for no RT group
5-year OS 58.3% for the RT group
Holliday et al. [76]2017Retrospective38Stage IV rectal cancer with synchronous distant metastases25 Gy/5 fx25 (14.75-42.25) months1-year OS 97%
2-year OS 86.2%
3-year OS 76%
1-year PFS 52.1%
2-year PFS 22.7%
3-year PFS 17%
Bisschop et al. [79]2017Prospective, multicenter phase 2 study50Stage IV rectal cancer with synchronous distant metastases25 Gy/5 fx8.1 (6-9.8) yearsMedian OS 3.8 ( 0.5–9.4) years for all patients
2-year OS 74%
5-year OS 38%
For 36 of 50 patients (72%) with radical (R0) primary tumor and metastatic site treatment, median OS 4.4 years, LR 5.6%, distant recurrence 80.6%
D'Hondt et al. [105]2017Retrospective multicenter study18Stage IV rectal cancer with synchronous liver metastases-20.5 (3.6–63.1) months3 patients died and 10 patients had tumor progression during the follow-up period
Median time to progression after liver surgery 4.2 (2.8–9.2) months
Labori et al. [84]2017Retrospective45Stage IV rectal cancer with synchronous liver metastases50 Gy/25 fx (53%) or 25 Gy/5 fx (47%)48 (6-85) monthsMedian OS 48.4 (43.3-54.8) months for all patients
For the 40 patients completing the treatment sequence, median OS 49.7 (45.2-57.1) months and recurrence free survival 13 (16-30.3) months
Salvador-Rosés et al. [75]2018Prospective35Stage IV rectal cancer with synchronous liver metastases50.4 Gy38 (11-64) monthsMedian disease free survival 26 (23–28) months
Median OS 53 (36-69) months for patients completing treatment strategy
Median OS 25 (7-42) months for patients not completing treatment strategy

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