Observation of a Dose–Control Relationship for Lung and Liver Tumors After Stereotactic Body Radiation Therapy

McCammon, R.; Schefter, Tracey E.; Gaspar, Laurie E.; Zaemisch, R.; Gravdahl, D.; Kavanagh, Brian D.

doi:10.1016/j.ijrobp.2008.03.062

Cited by 181 publications

(116 citation statements)

References 15 publications

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“…From the same authors group, a dose of at least 54 Gy in 3 fractions had been proposed to achieve 89% local control at 3 years for targets in lung and liver. 24 Accordingly, the authors from the University of Texas Southwestern showed a significant difference in local control between 60 Gy in 5 fractions and 30 Gy in 3 fractions (2 year 100 vs. 56%). 8 However, not all groups have identified this significant relationship in their patient populations.…”

Section: Discussionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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Section: Discussionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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“…Indeed, there is evidence that LC may be improved with higher fractional dose. In a dose-escalation series on patients with lung and liver metastases (19), the LC was improved on the uni-and multivariate analysis with greater nominal dose, i.e., with greater dose per fraction, since the number of fractions remained constant. A similar observation was reported in patients with hepatocellular carcinoma (20).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

et al. 2017

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Background: The net benefit from local ablative therapy for pulmonary oligometastases remains unknown.The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). Methods: Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni-and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. Results: Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dosefractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group. Conclusions: SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower longterm toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor. IntroductionBased on conceptual theories of breast cancer growth and dissemination, Hellman and Weichselbaum inferred the existence of a clinically and biologically relevant group of oligometastatic patients, in whom aggressive local therapy may prolong survival and even be a curative treatment option (1). The incentive for using stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) came from favorable results of surgical removal of oligometastases in different types of solid tumors (2). High rates of survival in treated compared with untreated patients have also been demonstrated for lung metastasectomy (3). However, the temporal and locational burden of oligometastatic state remains blurred and diffuse and-until now-no clear guidelines have been defined for the selection of patients who would really benefit from local ablative treatment.During the past decade, SABR emerged as a new standard of care for medically inoperable patients with early stage non-small-cell lung cancer. For oligometastatic diseases the benefit from SABR has been extrapolated from the experience with pr...

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“…McCammon et al 18 reported the data of 141 consecutive patients with 246 pulmonary or hepatic lesions (65 primaries, 181 metastasis) treated with three-fraction SBRT from Oct. 1999 through Aug. 2005. On univariate analysis, increased dose (either nominal or Equivalent Uniform Dose (EUD) and smaller Gross Tumor Volume were significant predictors of higher local control).…”

Section: Dosementioning

confidence: 99%

“…The dose required for a favorable result of the radiotherapy treatment might be 24-30 Gy in a single dose, 45-60 Gy in 3 fractions, 40-50 Gy in 5 fractions, 48-60 Gy in 6 fractions. 1,10,18,23,24 …”

Section: Dosementioning

confidence: 99%

Dose to organ at risk and dose prescription in liver SBRT

Rives

Izar

Parent

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Concerning liver metastasis, SBRT can be safely delivered using one to five fractions. An excellent local control is obtained with doses from 20 to 60 Gy. For primary hepatic tumors, results are also good, but the risk of hepatic toxicity related to liver pre-existent pathology must be taken into account. Radiation induced liver disease (RILD) is not frequent in its classical presentation, but modifications of liver enzymes are often observed. Other toxicities of SBRT on the duodenum, small bowel and biliary tract are also described. With respect to contraindications and dose limitations on surrounding structures, SBRT is well tolerated and takes place among curative treatment of liver tumors, as surgery, radiofrequency and embolization.

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Observation of a Dose–Control Relationship for Lung and Liver Tumors After Stereotactic Body Radiation Therapy

Cited by 181 publications

References 15 publications

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

Dose to organ at risk and dose prescription in liver SBRT

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