Repeated stereotactic body radiation therapy for recurrent oligometastases of rectal cancer in the lungs in an elderly patient

Introduction. Oligometastatic disease in colorectal cancer is considered a distinct form of tumor progression in which local treatment modalities (surgery, stereotactic body radiation therapy – SBRT) can provide long-term disease control. SBRT is particularly relevant in elderly patients with somatic limitations for repeated surgery and systemic chemotherapy.
Objective – to present a clinical case of successful repeated stereotactic body radiation therapy for recurrent metachronous oligometastases of rectal cancer in the lungs in an 80-year-old patient.
Materials and methods. A 80-year-old female patient with rectal cancer pT3N0M0 stage IIA underwent radical resection in 2019. In 2021, a solitary metastasis in the upper lobe of the right lung (S2) was detected and treated by thoracoscopic atypical resection. In 2023, a new lesion in the S6 segment of the right lung (0,4 cm to 0,7 cm) with low metabolic activity on PET/CT (SUV from 0,87 to 1,01) was registered. SBRT was delivered using volumetric modulated arc therapy (VMAT) with respiratory gating and cone-beam computed tomography (CBCT) at a dose of 15 Gy per fraction, total dose 45 Gy in 3 fractions on a Varian TrueBeam linear accelerator. In 2025, a recurrence at the previous resection site (S2) measuring 1,2 cm with SUV 1,63 appeared, and a second course of SBRT was given in the same regimen.
Results. After the first SBRT (2024), regression of the S6 lesion and formation of post-radiation changes without metabolic activity were observed. PET/CT at 6 and 12 months (December 2024, April 2025) confirmed stabilisation. After the second SBRT (February 2026), follow-up PET/CT in June 2026 showed that the previously active S2 focus was no longer visualised, with increasing post-radiation changes in the right lung without abnormal tracer uptake. No signs of local recurrence or progression were found.
Conclusion. This observation demonstrates that repeated stereotactic body radiation therapy is an effective and safe method of local control for recurrent oligometastases of colorectal cancer in the lungs in elderly patients, allowing avoidance of repeat surgeries and systemic therapy while maintaining quality of life.

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