Stereotactic radiotherapy vs. surgery in the treatment of colorectal cancer liver oligometastases

Purpose
The gold standard of treatment for resectable colorectal cancer liver oligometastases is a combination of surgery and chemotherapy. Stereotactic body radiotherapy (SBRT) is one of possible methods to provide local control of unresectable liver malignances. The purpose of our study is to compare the results of SBRT and surgery in patients with oligometastatic lesions associated with colorectal cancer.
Methods
The results of treatment of 62 patients in SBRT group and 83 patients in surgery group were retrospective investigated. Morbidity and toxicity in both groups were evaluated. Local control (LC) and overall (OS) within 2 years after treatment were assessed.
Results
There were no severe radiation-induced morbidity in the SBRT group, only 9,5% of patients developed grade 1 toxicity. In the surgery group complication rate was 18%, 1 lethal outcome was noted. The median follow-up was 24.6 months in the radiotherapy group and 22.8 months in the surgery group (p>0,05). 2 year LC rates was 62% in the SBRT group and 80% in the surgery group (p=0,019), and the 2-year OS was69.5% in the SBRT group and 84.7% in the surgery group (p = 0,03). The median mean dose was 54 Gy. Dose ≥51 Gy, was s a significant factor of improved local control.
Conclusion
SBRT is a safe and effective method of providing local control of colorectal cancer liver oligometastases. High-dose SBRT in hypofractionation regimen in selected patients with colorectal liver oligometastaseses comparable in terms of local control with surgery. Further studies are required to individualize the indications for this treatment method and optimize its methodology.