Stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma and oligometastatic liver disease

Abstract

BackgroundTo report our experience with SBRT in primary and secondary liver tumors.MethodsWe retrospectively analysed 55 patients (70 lesions) with a median follow-up of 10 months (range 1–57) treated from 2011 to 2016. All patients had not been eligible for other local treatment options. Median age was 64 years and 64% were male. 27 patients (36 lesions) suffered from hepatocellular carcinoma (HCC, Child A:78%, Child B:18%, Child C:4%), 28 patients (34 lesions) had oligometastatic liver disease (MD). Treatment planning was based on 4D-CT usually after placement of fiducials. Dose and fractionation varied depending on localization and size, most commonly 3 × 12.5 Gy (prescribed to the surrounding 65%-isodose) in 56% and 5x8Gy (80% isodose) in 20% of the treated lesions.ResultsLocal recurrence was observed in 7 patients (13%) and 8 lesions (11%), resulting in estimated 1- and 2-year local control rates (LC) of 91 and 74%. Estimated 1- and 2-year rates of Freedom from hepatic failure (FFHF) were 42 and 28%. Number of lesions was predictive for LC and FFHF in the entire cohort. Estimated 1- and 2-year overall survival (OS) was 76 and 57%. OS was significantly affected by number of treated lesions and performance status. In the HCC subgroup, pretreatment liver function and gender were also predictive for OS. Maximum acute non-hepatic toxicity was grade 1 in 16% and grade 2 in 10% of the patients. Three HCC patients (11%) developed marked deterioration of liver function (grade 3/4).ConclusionsSBRT resulted in high local control and acceptable survival rates in patients with HCC or MD not amendable to other locally-ablative treatment options with limited toxicity. Care should be taken in HCC patients with Child B cirrhosis.

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

“…Multi-modality diagnostic imaging was used for the evaluation of metastatic disease in most studies reviewed [47]. Although several studies did not specify modalities used in OMD workup [32,83], in areas of focused disease-site evaluations, highly specific imaging was utilized (e.g., contrast-enhanced biphasic liver CT for liver metastases [30], PSMA-PET for prostate OMD [37]). While there was no consensus to recommend specific imaging modalities as a requirement for OMD workup, there was consensus to recommend PET/CT, contrast-enhanced chest/abdominal and pelvis CT scans, and/or MR brain or spine (when indicated) for diagnostic evaluation.…”

Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

“…Treatment paradigms have changed dramatically in favor of local treatments in the last decades though. Even in inoperable patients, there is now emerging evidence of survival benefit or potential cure in inoperable patients receiving local treatments[3,4]. In consequence, local therapies should be considered in patients not eligible for curative surgery, or as a part of a strategy to bridge patients awaiting liver transplantation according to common guidelines[5].…”

Radiomics for liver tumours

“…With the introduction of image guidance and conformal radiotherapy techniques, the treatment of both primary and secondary liver tumours has experienced significant improvement over the past few years, leading to increased local control rates and decreased normal tissue toxicity [14][15][16][17][18][19].…”