Colorectal Pulmonary Metastases: Pulmonary Metastasectomy or Stereotactic Radiotherapy?

Martijn van Dorp; Constantia Trimbos; Wilhelmina H Schreurs; Chris Dickhoff; David J Heineman; Bart Torensma; Geert Kazemier; Frank J C van den Broek; Ben J Slotman; Max Dahele

doi:10.3390/cancers15215186

Colorectal Pulmonary Metastases: Pulmonary Metastasectomy or Stereotactic Radiotherapy?

Cancers (Basel). 2023 Oct 28;15(21):5186. doi: 10.3390/cancers15215186.

Authors

Martijn van Dorp^{1

2}, Constantia Trimbos^{1

2}, Wilhelmina H Schreurs³, Chris Dickhoff^{1

2}, David J Heineman^{1

2}, Bart Torensma⁴, Geert Kazemier^{2

5}, Frank J C van den Broek⁶, Ben J Slotman^{2

7}, Max Dahele^{2

7}

Affiliations

¹ Amsterdam University Medical Center, Location VUmc, Department of Cardiothoracic Surgery, 1007 MB Amsterdam, The Netherlands.
² Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands.
³ Northwest Clinics, Department of Surgery, 1815 JD Alkmaar, The Netherlands.
⁴ Department of Anesthesiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
⁵ Amsterdam University Medical Center, Location VUmc, Department of Surgery, 1007 MB Amsterdam, The Netherlands.
⁶ Máxima Medical Centra, Department of Surgery, 5657 EG Veldhoven, The Netherlands.
⁷ Amsterdam University Medical Center, Location VUmc, Department of Radiation Oncology, 1007 MB Amsterdam, The Netherlands.

Abstract

Background: Pulmonary metastasectomy and stereotactic ablative radiotherapy (SABR) are both guideline-recommended treatments for selected patients with oligometastatic colorectal pulmonary metastases. However, there is limited evidence comparing these local treatment modalities in similar patient groups.

Methods: We retrospectively reviewed records of consecutive patients treated for colorectal pulmonary metastases with surgical metastasectomy or SABR from 2012 to 2019 at two Dutch referral hospitals that had different approaches toward the local treatment of colorectal pulmonary metastases, one preferring surgery, the other preferring SABR. Two comparable patient groups were identified based on tumor and treatment characteristics.

Results: The metastasectomy group comprised 40 patients treated for 69 metastases, and the SABR group had 60 patients who were treated for 90 metastases. Median follow-up was 38 months (IQR: 26-67) in the surgery group and 46 months (IQR: 30-79) in the SABR group. Median OS was 58 months (CI: 20-94) in the metastasectomy group and 70 months (CI: 29-111) in the SABR group (p = 0.23). Five-year local recurrence-free survival (LRFS) was 44% after metastasectomy and 30% after SABR (p = 0.16). Median progression-free survival (PFS) was 15 months (CI: 3-26) in the metastasectomy group and 10 months (CI: 6-13) in the SABR group (p = 0.049). Local recurrence rate was 12.5/7.2% of patients/metastases respectively after metastasectomy and 38.3/31.1% after SABR (p < 0.001). Lower BED Gy₁₀ was correlated with an increased likelihood of recurrence (p = 0.025). Clavien Dindo grade III-V complication rates were 2.5% after metastasectomy and 0% after SABR (p = 0.22).

Conclusion: In this retrospective cohort study, pulmonary metastasectomy and SABR had comparable overall survival, local recurrence-free survival, and complication rates, despite patients in the SABR group having a significantly lower progression-free survival and local control rate. These data would support a randomized controlled trial comparing surgery and SABR in operable patients with radically resectable colorectal pulmonary metastases.

Keywords: RCT; SABR; colorectal lung metastases; oligometastatic colorectal cancer; pulmonary metastasectomy.

Grants and funding

This research received no external funding.