title: Phase II study of helical tomotherapy in the multidisciplinary treatment of oligometastatic colorectal cancer.
abstract: BACKGROUND
  Complete metastasectomy provides a real chance for long-term survival in patients with oligometastatic colorectal cancer (CRC). For inoperable patients, we evaluated in this study intensity-modulated and image-guided radiotherapy (IMRT-IGRT) by helical tomotherapy.
  
  
  METHODS
  Twenty-four CRC patients with ≤ 5 metastases were enrolled, receiving a dose of 50 Gy in fractions of 5 Gy. No limitations concerning dimension or localization of the metastases were imposed. Whole body PET-CT was performed at baseline and 3 months after the initiation of RT to evaluate the metabolic response rate according to PET Response Criteria in Solid Tumors (PERCIST) version 1.0.
  
  
  RESULTS
  A total of 53 metastases were treated. Seventeen patients (71%) received previously ≥ 1 line of chemotherapy for metastatic disease, displaying residual (n = 7) or progressive (n = 10) metabolic active oligometastatic disease at time of inclusion. Most common sites were the lung, liver and lymphnodes. One patient (4%) experienced grade 3 dysphagia. Twenty-two patients were evaluated by post-treatment PET-CT. Twelve patients achieved a complete (n = 6) or partial (n = 6) metabolic response, resulting in an overall metabolic response rate of 55%. At a median follow-up of 10 months, 7 patients (29%) are in remission, of which 5 received previous chemotherapy with residual oligometastatic disease at time of inclusion. The actuarial 1-year local control, progression-free survival, and overall survival were 54%, 14% and 78%.
  
  
  CONCLUSIONS
  Helical tomotherapy delivering 10 fractions of 5 Gy resulted in a metabolic response rate of 55%, and appeared to be attractive as consolidation of inoperable oligometastatic disease after effective chemotherapy.
  
  
  BACKGROUND
  Eudract 2008-008300-40; NCT00807313.
authors.affiliation: Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. Benedikt.engels@gmail.com
authors.forename: Benedikt
authors.initials: B
authors.lastname: Engels
authors.forename: Thierry
authors.initials: T
authors.lastname: Gevaert
authors.forename: Hendrik
authors.initials: H
authors.lastname: Everaert
authors.forename: Peter
authors.initials: P
authors.lastname: De Coninck
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sermeus
authors.forename: Nicolas
authors.initials: N
authors.lastname: Christian
authors.forename: Guy
authors.initials: G
authors.lastname: Storme
authors.forename: Dirk
authors.initials: D
authors.lastname: Verellen
authors.forename: Mark
authors.initials: M
authors.lastname: De Ridder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents