This is an experimental study without drug or device, randomized, open-label, non-profit, sponsored by the IRCCS Sacro Cuore Don Calabria Hospital in Negrar, which will take place at the Department of Advanced Oncological Radiotherapy and 18 other Italian centers.
The reason for this research study is to evaluate whether stereotactic radiotherapy treatment (SABR), in addition to the systemic chemotherapy treatment foreseen by clinical practice for low-intermediate risk oligometastatic colorectal cancer, is able to:
* delay possible local recurrence and/or distant polymetastatic progression * improve disease-free survival * reduce side effects in the short and long term
thus inducing an improvement in the quality of life of patients suffering from this type of pathology.
Therefore, as part of this randomized study, before starting first or second line systemic therapy for his tumor, the patient will be randomized to one of the following treatment arms:
* Experimental arm: ablative stereotactic radiotherapy on all sites of oligometastatic disease (from 1 to 3 sites, performed at most within the second cycle of systemic therapy) * Control arm: no ablative stereotactic radiotherapy to sites of oligometastatic disease
The procedure that is intended to be tested in the experimental arm is a stereotactic radiotherapy treatment on oligometastases (up to a maximum of 3 sites), with ablative dosage (effective biological dose \>100 Gy), performed before the start of systemic therapy of I or II line (at most within the second cycle of the same).
It is hoped that the addition of this type of radiotherapy will increase the potential clinical benefit of the treatment in the context of colorectal cancer.
Age ≥18 years
Histologically confirmed CRC
Low and intermediate risk oligometastatic colorectal cancer with 1 to 3 metastases, candidate to I or II line systemic treatment (Low risk: 1 to 3 metastases and cumulative tumor volume smaller than 10 cm3; Intermediate risk: 1 to 3 metastases and cumulative tumor volume bigger than 10 cm3).
Controlled primary tumor regardless of primary surgery or primary systemic treatment
Age < 18 years
Brain metastases
Having more than 3 metastases
Malignant pleural effusion or ascites
Parallel
SABR
RadiationA biological effective dose (BED) ≥125 Gy10 should be administered when constraints to the organs at risk (OARs) are respected \[10\]; if not possible, a BED schedule no lower than 100 Gy10 should be administered. In compliance with these instructions, treatment schedules, total dose and fractionation will be prescribed according to the clinical practice of each participating Center. The constraints for the organs at risk will be respected according to the available data. In any case, biological effective dose (BED) ≥125 Gy10 should be administered when constraints to the organs at risk (OARs) are respected; if not possible, a BED schedule no lower than 100 Gy10 should be administered. SABR will be administered before systemic treatment start, or before starting the second systemic treatment cycle at the latest.
Progression-free survival (PFS).
PFS is defined as the time between randomization to the radiological evidence of disease progression. For patients with a PFS event, PFS will be calculated as the time interval from the date of randomization to the date of first objective evidence of disease progression or death from any cause, whichever occurs first. For patients without a PFS event, PFS will be censored at the date of the last radiographic assessment prior to the date of study end.
Time to the polymetastatic conversion (tPMC)
tPMC will be defined as the time between randomization to the date of radiological occurrence of \>5 new metastases. For patients without a tPMC event, time to tPMC will be censored at the date of the last radiographic assessment prior to the study end date.
Local control (LC): the time between randomization to the date of radiological development of local progression after SABR.
For patients without LC, time to LC will be censored at the date of the last radiographic assessment prior to the study end date.
Overall survival (OS)
OS will be defined as the time between randomization to the date of death or last follow-up. For patients who are alive at the time of the study end date, OS time will be censored on the last date the patient is known to be alive or the study end date, whichever occurs first.
Time to start of the next systemic treatment line (NEST)
For patients without a NEST, time to NEST will be censored at the date of the last patient visit before the study end date.
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