The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer

• Published in: Current colorectal cancer reports Vol. 17; no. 6; pp. 103 - 112
• Main Authors: Ku, Eric, Yeakel, John, Gan, Meng, Ahmed, Faisal, Harris, Jeremy P., Kuo, Jeffrey V., Wolf, Ronald, Fernando, Dayantha M., Seyedin, Steven N.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2021
• Subjects: Colorectal Surgery; Medicine; Medicine & Public Health; Oncology; Proctology; Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer (P Lee and A Raldow; Section Editors; Topical Collection on Radiation Therapy and Radiation Therapy Innovations in Colorectal Cancer; Oligometastatic; Ablative radiation; Y-90; Liver metastases; Colorectal cancer; SBRT
• ISSN: 1556-3790; 1556-3804
• DOI: 10.1007/s11888-021-00472-9

Purpose of Review This review describes recent data supporting locoregional ablative radiation in the treatment of oligometastatic colorectal cancer liver metastases. Recent Findings Stereotactic body radiotherapy (SBRT) demonstrates high rates of local control in colorectal cancer liver metastases when a biologically equivalent dose of > 100 Gy is delivered. Future innovations to improve the efficacy of SBRT include MRI-guided radiotherapy (MRgRT) to enhance target accuracy, systemic immune activation to treat extrahepatic disease, and genomic customization. Selective internal radiotherapy (SIRT) with y-90 is an intra-arterial therapy that delivers high doses to liver metastases internally which has shown to increase liver disease control in phase 3 trials. Advancements in transarterial radioembolization (TARE) dosimetry could improve local control and decrease toxicity. Summary SBRT and SIRT are both promising options in treating unresectable metastatic colorectal cancer liver metastases. Identification of oligometastatic patients who receive long-term disease control from either therapy is essential. Future advancements focusing on improving radiation design and customization could further improve efficacy and toxicity.