Stereotactic Body Radiotherapy versus Surgery for Lung Metastases from Colorectal Cancer: Single-Institution Results

SIMPLE SUMMARY: Colorectal cancer (CRC) is one of the most common malignancies in developed countries and 50% of patients will progress to metastatic disease during follow-up, the liver and lungs being the most common sites. For lung metastases in particular, although surgery has historically been the treatment of choice, the use of stereotactic body radiotherapy (SBRT) is increasing. SBRT is known to be a well-tolerated and less invasive alternative to surgery, with excellent results in terms of local control and toxicity. The aim of this retrospective, single-center study was to compare local thoracic control rates with SBRT against those with surgery. ABSTRACT: Background: Surgery and stereotactic body radiotherapy (SBRT) are two of the options available as local treatments for pulmonary oligometastases from colorectal cancer (CRC). We hypothesized that SBRT would have, at least, a similar local control rate to surgery. Methods: We identified an initial cohort of 100 patients with CRC who received SBRT or surgery for lung metastases. This was then narrowed down to 75 patients: those who underwent surgery (n = 50) or SBRT (n = 25) as their first local thoracic treatment between 1 January 2004 and 29 December 2017. The Kaplan–Meier method was used to calculate lung-progression-free survival (L-PFS) and overall survival (OS). Results: The 1 and 2-year L-PFS was 85% and 70% in the surgical group and 87% and 71% in the SBRT group, respectively (p = 0.809). No significant differences were found between the two groups in terms of OS. The biologically effective dose (BED), age and initial CRC stage did not have a significant effect on local control or survival. No grade 3 or above acute- or late-toxicity events were reported. Conclusions: These results add retrospective evidence that SBRT and surgery have similar results in terms of OS and local control in patients with lung oligometastases from CRC.