Peritoneal metastases from colorectal cancer managed by stereotactic body radiation therapy: presentation of a clinical case and review of literature
Bibliographic record
Abstract
Abstract Peritoneal metastasis (PM, or peritoneal carcinomatosis) is often associated with dismal prognosis. The treatment of peritoneal metastasis depends on several factors, including the type of primary cancer, the extent of metastasis and the patient’s overall health condition. Apart from systemic chemotherapy and cytoreductive surgery (CRS), locoregional therapies such as hyperthermic intraperitoneal chemotherapy (HIPEC) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) may improve tumour control. CRS is a complex procedure with high morbidity, performed only in approximately 25% of all eligible patients and the efficiency of other non-surgical therapies is not well known. The place of radiation therapy needs to be defined. A 62-year-old woman was referred for surgery for a few days’ history of large bowel obstruction. A previous abdominopelvic CT showed an obstructive 3-cm mass in the proximal ascending colon, associated with small bowel dilatation. Right hemi-colectomy was performed. Work-up demonstrated on MRI (magnetic resonance imaging) sub-centimetric secondary liver lesions. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ruled out other metastatic lesions. After multidisciplinary discussion, peri-operative systemic therapy based on FOLFOX-Bevacizumab was offered and was associated with stable disease for 7 months. Unfortunately, peritoneal progression was detected on PET/CT imaging. FOLFIRI-Bevacizumab was offered as second line systemic therapy followed by resection of residual masses. The patient was considered in remission for 5 months thereafter. A second isolated peritoneal relapse occurred involving the same 2 distinct sites. Second line chemotherapy was re-challenged. The oligorecurrent PM lesions were considered as non-operable. After multidisciplinary team discussion, stereotactic body radiation therapy (SBRT) was decided. The relapse sites were treated with 48 Gy, delivered in 6 fractions of 8 Gy given every other day. At the 22-month follow-up, the patient showed no signs of relapse on CT imaging and no treatment-related toxicities. Isolated peritoneal oligometastatic metastases are associated with poor prognosis. Cytoreductive surgery remains the historical standard of care treatment but represents a minority of all eligible patients. Our case and few other reports suggest that SBRT is a safe, reasonable, and non-invasive treatment option.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".