CASE REPORT article
Front. Oncol.
Sec. Radiation Oncology
Innovative Radiotherapy Strategies in Advanced Colon Cancer with Oligometastasis: A Case of Online Adaptive Radiotherapy and Lattice Stereotactic Re-Irradiation
School of Clinical Medicine, Chengdu Medical College, Chengdu, China
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Abstract
Conventional radiotherapy demonstrates limited efficacy in advanced colon cancer with bulky radio-resistant metastatic lesions. A case report detailing the outcomes and toxicity profile of a 71-year-old female with progressive colon cancer and pulmonary oligometastasis treated using an individualized radiotherapy approach is presented. The patient, with an ECOG performance status of 3, presented severe symptoms including partial intestinal obstruction, intractable cough, and hemoptysis following multiple lines of systemic therapy and prior intensity-modulated radiotherapy (IMRT) to lung metastases (5750 cGy in 23 fractions, delivered 17months earlier). Following multidisciplinary evaluation, online adaptive radiotherapy (oART) using a fan-beam CT-guided linear accelerator system was administered to the ascending colon primary tumor (50 Gy in 25 fractions). Concurrently, spatially fractionated radiotherapy (SFRT) was employed for the radio-resistant bulky pulmonary lesion: lattice radiation therapy (LRT) PTVpeak (22.5 Gy in 3 fractions) followed by sequential conventional fractionation to PTV (30 Gy in 15 fractions). No acute radiotherapy-related adverse events were observed. At 11-month follow-up, both target lesions exhibited partial response (PR) on imaging, accompanied by complete alleviation of intestinal obstruction and hemoptysis. Consequently, the patient's performance status improved to ECOG 1. oART appears to be a viable approach for symptom palliation and disease control in advanced colon cancer with emergent complications, particularly among patients with compromised functional status. Additionally, SFRT shows potential efficacy in re-irradiation settings for bulky, radio-resistant lesions. The combined use of adaptive precision radiotherapy and spatially fractionated techniques may therefore represent an emerging therapeutic paradigm for oligometastatic colon cancer, meriting further evaluation in prospective clinical trials.
Summary
Keywords
Ascending colon cancer, Lung metastasis, Online adaptive radiotherapy (oART), Re-irradiation, spatially fractionated radiotherapy (SFRT)
Received
25 September 2025
Accepted
18 February 2026
Copyright
© 2026 Ren, Li, Luo, Zeng, Xu and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fei Cao
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