Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study

Abstract

The feasibility, toxicity and tumor response of stereotactic body radiation therapy (SBRT) for treatment of primary and metastastic liver tumors was investigated. From October 2002 until June 2006, 25 patients not suitable for other local treatments were entered in the study. In total 45 lesions were treated, 34 metastases and 11 hepatocellular carcinoma (HCC). Median follow-up was 12.9 months (range 0.5-31). Median lesion size was 3.2 cm (range 0.5-7.2) and median volume 22.2 cm3 (range 1.1-322). Patients with metastases, HCC without cirrhosis, and HCC < 4 cm with cirrhosis were mostly treated with 3 x 12.5 Gy. Patients with HCC > or =4 cm and cirrhosis received 5 x 5 Gy or 3 x 10 Gy. The prescription isodose was 65%. Acute toxicity was scored following the Common Toxicity Criteria and late toxicity with the SOMA/LENT classification. Local failures were observed in two HCC and two metastases. Local control rates at 1 and 2 years for the whole group were 94% and 82%. Acute toxicity grade > or =3 was seen in four patients; one HCC patient with Child B developed a liver failure together with an infection and died (grade 5), two metastases patients presented elevation of gamma glutamyl transferase (grade 3) and another asthenia (grade 3). Late toxicity was observed in one metastases patient who developed a portal hypertension syndrome with melena (grade 3). SBRT was feasible, with acceptable toxicity and encouraging local control. Optimal dose-fractionation schemes for HCC with cirrhosis have to be found. Extreme caution should be used for patients with Child B because of a high toxicity risk.

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

“…As described in a previous paper, one patient developed a portal hypertension syndrome with esophageal varices and one episode of melena after two SBRT treatments. 5,13 A case of a biliary tree dilatation was observed in a patient treated for a centrally located liver metastases with 50.25 Gy.…”

“…Details about this procedure have been reported earlier. 5,[11][12][13] From 2011, only one large contrast enhanced planning CT in the venous phase was acquired. The tumor delineations have always been reviewed by an experienced radiologist.…”

Dose to organ at risk and dose prescription in liver SBRT

“…Esophagus A death due to bleeding on oesophageal varices, probably linked to cirrhosis without any other oesophageal toxicity, has been observed. 46 Some liver SBRT protocols define constraints for esophagus. Méndez Romero et al 46 limits to 5 cc the oesophageal volume receiving more than 21 Gy in 3-5 fractions.…”

“…46 Some liver SBRT protocols define constraints for esophagus. Méndez Romero et al 46 limits to 5 cc the oesophageal volume receiving more than 21 Gy in 3-5 fractions.…”

“…Kydney Constraints proposed for the two kidneys are V 15 lower than 35%, and for the right kidney lower than 33%. 17,22,46 Spinal cord The dose has to be restricted to 18 Gy 12,17,22 or the V 27 must be inferior to 0.5 cc. 28 …”