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Kyrochristou I, Giannakodimos I, Tolia M, Georgakopoulos I, Pararas N, Mulita F, Machairas N, Schizas D. Robotic Stereotactic Body Radiation Therapy for Oligometastatic Liver Metastases: A Systematic Review of the Literature and Evidence Quality Assessment. Diagnostics (Basel) 2024; 14:1055. [PMID: 38786353 DOI: 10.3390/diagnostics14101055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION The role of stereotactic body radiation therapy (SBRT) as a locally effective therapeutic approach for liver oligometastases from tumors of various origin is well established. We investigated the role of robotic SBRT (rSBRT) treatment on oligometastatic patients with liver lesions. MATERIAL AND METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The PubMed and Scopus databases were accessed by two independent investigators concerning robotic rSBRT for liver metastases, up to 3 October 2023. RESULTS In total, 15 studies, including 646 patients with 847 lesions that underwent rSBRT, were included in our systematic review. Complete response (CR) after rSBRT was achieved in 40.5% (95% CI, 36.66-44.46%), partial response (PR) in 19.01% (95% CI, 16.07-22.33%), whereas stable disease (SD) was recorded in 14.38% (95% CI, 11.8-17.41%) and progressive disease (PD) in 13.22% (95% CI, 10.74-16.17%) of patients. Progression-free survival (PFS) rates at 12 and 24 months were estimated at 61.49% (95% CI, 57.01-65.78%) and 32.55% (95% CI, 28.47-36.92%), respectively, while the overall survival (OS) rates at 12 and 24 months were estimated at 58.59% (95% CI, 53.67-63.33%) and 44.19% (95% CI, 39.38-49.12%), respectively. Grade 1 toxicity was reported in 13.81% (95% CI, 11.01-17.18%), Grade 2 toxicity in 5.57% (95% CI, 3.82-8.01%), and Grade 3 toxicity in 2.27% (955 CI, 1.22-4.07%) of included patients. CONCLUSIONS rSBRT represents a promising method achieving local control with minimal toxicity in a significant proportion of patients. Further studies are needed to evaluate the role of rSBRT in the management of metastatic liver lesions.
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Affiliation(s)
| | - Ilias Giannakodimos
- Second Department of Surgery, General Hospital of Nikaia, 18454 Athens, Greece
| | - Maria Tolia
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Ioannis Georgakopoulos
- Radiation Oncology Unit, First Department of Radiology, Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Francesk Mulita
- Department of General Surgery, University General Hospital of Patras, 26504 Patras, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Benson KRK, Sandhu N, Zhang C, Ko R, Toesca DAS, Lee PE, Von Eyben R, Diehn M, Gensheimer M, Maxim PG, Bush K, Loo BW, Soltys SG, Pollom EL, Chang DT. Local Recurrence Outcomes of Colorectal Cancer Oligometastases Treated With Stereotactic Ablative Radiotherapy. Am J Clin Oncol 2021; 44:559-564. [PMID: 34534143 DOI: 10.1097/coc.0000000000000864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of this study was to report local failure (LF) outcomes and associated predictors in patients with oligometastatic colorectal cancer (CRC) treated with stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS We retrospectively reviewed patients with CRC metastases to the brain, liver, spine, or lung treated with SABR between 2001 and 2016. Time to LF was summarized using cumulative incidence of LF curves with death as a competing risk. RESULTS The analysis included a total of 130 patients and 256 lesions. Of the metastases treated, 129 (50%) were brain, 50 (20%) liver, 49 (19%) spine, and 28 (11%) lung. Median gross tumor volume was 24 mL for liver metastases, 2 mL for brain metastases, 4 mL for spine metastases, and 1 mL for lung metastases. The overall 1, 2, and 3-year cumulative incidence of LF rates were 21.6% (16.5, 27.1), 28.2% (22.3, 34.4), and 31.5% (25.2, 38.0), respectively. LF was highest among the liver metastases (1 y: 26.0%, 2 y: 38.5%), followed by spine (1 y: 25.1%, 2 y: 31.1%), brain (1 y: 20%, 2 y: 25.2%), and lung (1 y: 13.7%, 2 y: insufficient data). Metastases from right-sided primary CRC were significantly more likely to have LF (P=0.0146, HR=2.23). Biologically effective dose>70 Gy, defined using a standard linear quadratic model using α/β ratio of 10 on the individual lesion level, and pre-SABR chemotherapy were also significant predictors of LF (P= 0.0009 and 0.018, respectively). CONCLUSIONS CRC metastases treated with SABR had significantly higher rates of LF if they originated from right-sided primary CRC, compared with left-sided. Liver metastases had the highest rates of LF compared with other metastatic sites. Thus, CRC liver metastases and metastases from right-sided CRC may benefit from more aggressive radiotherapy.
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Affiliation(s)
- Kathryn R K Benson
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Carrie Zhang
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Ryan Ko
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Diego A S Toesca
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Phoebe E Lee
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Rie Von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Peter G Maxim
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Karl Bush
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA
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Significance of liver metastasis volume in breast cancer patients treated with stereotactic body radiotherapy. Strahlenther Onkol 2021; 198:247-253. [PMID: 34477885 DOI: 10.1007/s00066-021-01845-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study analyzed the impact of liver metastasis (LM) volume on treatment outcomes in breast cancer (BC) patients treated with stereotactic body radiotherapy (SBRT). METHODS This single-institution retrospective analysis included 40 oligometastatic (≤ 5 metastases) BC patients with 58 liver metastases treated with SBRT between April 2013 and March 2021. The prognostic factors for local control (LC), overall survival (OS), and progression-free survival (PFS) rates were assessed. RESULTS Median follow-up time was 28.1 months. Isolated and solitary LM were seen in 26 (65%) and 24 (60%) patients, respectively. Median time to disease recurrence was 10.7 months post liver SBRT. The 2‑year OS, PFS, and LC rates were 71.4%, 27.5%, and 86.8%, respectively. In univariate analysis, patients with a gross tumor volume (GTV) of ≤ 6 cc and a planning target volume (PTV) of ≤ 38 cc demonstrated a significantly better median OS than those with GTV > 6 cc and PTV > 38 cc. In multivariate analysis, the predictive factors for worse OS were GTV > 6 cc (HR = 3.07 [95% CI, 1.14-8.22; p = 0.03]) and PTV > 38 cc (HR = 5.91 [95% CI, 1.92-18.21; p = 0.002]). No significant factor for PFS was found. Only 2 patients experienced rib fracture at 4 and 6 months post treatment, and 1 patient had a grade II duodenal ulcer. CONCLUSION Liver SBRT is an effective and safe treatment option for oligometastatic BC patients with excellent LC, promising survival, and limited toxicity. Patients with smaller tumors displayed better OS than their counterparts, validating the effectiveness of a local treatment for this group.
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Voglhuber T, Eitz KA, Oechsner M, Vogel MME, Combs SE. Analysis of using high-precision radiotherapy in the treatment of liver metastases regarding toxicity and survival. BMC Cancer 2021; 21:780. [PMID: 34229642 PMCID: PMC8259027 DOI: 10.1186/s12885-021-08488-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hepatic metastases occur frequently in the context of many tumor entities. Patients with colorectal carcinoma have already developed liver metastases in 20% at the time of diagnosis, and 25–50% develop metastases in the further course of the disease and therapy. The frequent manifestation and the variable appearance of liver metastases result in an interdisciplinary challenge, regarding treatment management. The aim of this study was to evaluate high-precision stereotactic body radiotherapy (SBRT) for liver metastases. Methods A cohort of 115 patients with 150 irradiated liver metastases was analyzed. All metastases were treated between May 2004 and January 2020 using SBRT. A contrast-enhanced computed tomography (CT) was performed in all patients for treatment planning, followed by image-guided high-precision radiotherapy using cone-beam CT. A median cumulative dose of 35 Gy and a median single dose of 7 Gy was applied. Results Median OS was 20.4 months and median LC was 35.1 months with a 1-year probability of local failure of 18% (95%-CI: 12.0–24.3%). In this cohort, 18 patients were still alive at the time of evaluation. The median FU-time in total was 11.4 months and for living patients 26.6 months. 70.4% of patients suffered from acute toxicities. There were several cases of grade 1 and 2 toxicities, such as constipation (13.9%), nausea (24.4%), loss of appetite (7.8%), vomiting (10.4%), diarrhea (7.8%), and abdominal pain (16.5%). 10 patients (8.7%) suffered from grade 3 toxicities. Late toxicities affected 42.6% of patients, the majority of these affected the gastrointestinal system. Conclusion SBRT is becoming increasingly important in the field of radiation oncology. It has evolved to be a highly effective treatment for primary and metastasized tumors, and offers a semi-curative treatment option also in the case of oligometastatic patients. Overall, it represents a very effective and well-tolerated therapy option to treat hepatic metastases. Based on the results of this work and the studies already available, high-precision radiotherapy should be considered as a valid and promising treatment alternative in the interdisciplinary discussion.
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Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.
| | - Kerstin A Eitz
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Fonseca GM, Braghiroli MIFM, Pirola Kruger JA, Coelho FF, Herman P. Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies? Surg Oncol Clin N Am 2020; 30:125-142. [PMID: 33220801 DOI: 10.1016/j.soc.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of multidisciplinary approach and patient selection.
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Affiliation(s)
- Gilton Marques Fonseca
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Maria Ignez Freitas Melro Braghiroli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, and Rede D'Or Sao Paulo, Av. Dr. Arnaldo, 251 - São Paulo, SP, Brazil. CEP: 01246-000, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil.
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Berkovic P, Gulyban A, Defraene G, Swenen L, Dechambre D, Nguyen PV, Jansen N, Mievis C, Lovinfosse P, Janvary L, Lambrecht M, De Meerleer G. Stereotactic robotic body radiotherapy for patients with oligorecurrent pulmonary metastases. BMC Cancer 2020; 20:402. [PMID: 32384918 PMCID: PMC7206759 DOI: 10.1186/s12885-020-06906-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Our aim is to report treatment efficacy and toxicity of patients treated by robotic (Cyberknife®) stereotactic body radiotherapy (SBRT) for oligorecurrent lung metastases (ORLM). Additionally we wanted to evaluate influence of tumor, patient and treatment related parameters on local control (LC), lung and distant progression free- (lung PFS/Di-PFS) and overall survival (OS). METHODS Consecutive patients with up to 5 ORLM (confirmed by FDG PET/CT) were included in this study. Intended dose was 60Gy in 3 fractions (prescribed to the 80% isodose volume). Patients were followed at regular intervals and tumor control and toxicity was prospectively scored. Tumor, patient and treatment data were analysed using competing risk- and Cox regression. RESULTS Between May 2010 and March 2016, 104 patients with 132 lesions were irradiated from primary lung carcinoma (47%), gastro-intestinal (34%) and mixed primary histologies (19%). The mean tumor volume was 7.9 cc. After a median follow up of 22 months, the 1, 2 and 3 year LC rate (per lesion) was 89.3, 80.0 and 77.8% respectively. The corresponding (per patient) 1, 2 and 3 years lung PFS were 66.3, 50.0, 42.6%, Di-PFS were 80.5, 64.4, 60.6% and OS rates were 92.2, 80.9 and 72.0% respectively. On univariable analysis, gastro-intestinal (GI) as primary tumor site showed a significant superior local control versus the other primary tumor sites. For OS, significant variables were primary histology and primary tumor site with a superior OS for patients with metastases of primary GI origin. LC was significantly affected by the tumor volume, physical and biologically effective dose coverage. Significant variables in multivariable analysis were BED prescription dose for LC and GI as primary site for OS. The vast majority of patients developed no toxicity or grade 1 acute and late toxicity. Acute and late grade 3 radiation pneumonitis (RP) was observed in 1 and 2 patients respectively. One patient with a centrally located lesion developed grade 4 RP and died due to possible RT-induced pulmonary hemorrhage. CONCLUSIONS SBRT is a highly effective local therapy for oligorecurrent lung metastases and could achieve long term survival in patients with favourable prognostic features.
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Affiliation(s)
- Patrick Berkovic
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Akos Gulyban
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 rue Héger-Bordet, 1000 Brussels, Belgium
| | - Gilles Defraene
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Laurie Swenen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - David Dechambre
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Paul Viet Nguyen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Nicolas Jansen
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Carole Mievis
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Pierre Lovinfosse
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Levente Janvary
- Department of Radiation Oncology, University Hospital of Liège, Avenue de L’Hòpital 1, 4000 Liège, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Ihnát P, Skácelíková E, Vávra P, Jonszta T, Ihnát Rudinská L, Tomášková H. Novel strategy in the treatment of liver metastases - Hepatic resection combined with stereotactic body radiotherapy. Asian J Surg 2020; 43:902-906. [PMID: 31911035 DOI: 10.1016/j.asjsur.2019.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To evaluate the safety, feasibility and outcomes of patients treated for colorectal liver metastases (CLM) with an innovative combined approach - hepatic resection and Stereotactic body radiotherapy (SBRT) using CyberKnife® system. METHODS This was a retrospective cohort study conducted in a single institution. Patients with CLM and no evidence of extrahepatic disease were included during a 6-year study period. RESULTS In total, 19 patients with 63 liver lesions underwent liver resection combined with SBRT of unresectable lesions. Major hepatectomy was performed in 42.1% patients; postoperative complications were noted in 31.6% patients. 27 unresectable lesions were treated by SBRT with a total dose of 50-60 Gy in five fractions. The median follow-up of study patients was 29.7 ± 20.58 months. Local control of CLM at 1 and 2 years was achieved in 89.5% of patients. Out-of-field hepatic recurrence was diagnosed in 63.1% patients. The 1-year disease-free survival (DFS) was 52.6%; 2-year DFS was 31.6%. The overall actuarial survival rates at 1 and 2 years were 88.2% and 50.4%. CONCLUSION Liver resection combined with SBRT presents a promising therapeutic option for patients with CLM which traditionally are unresectable. The additional use of SBRT allows for the effective clearance of the disease for thoroughly selected patients.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
| | - Eva Skácelíková
- Department of Oncology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Petr Vávra
- Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic; Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Lucia Ihnát Rudinská
- Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 708 52, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic
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Robotic stereotactic radiotherapy for liver oligometastases from colorectal cancer: a single-center experience. Radiol Med 2019; 124:870-876. [PMID: 31104277 DOI: 10.1007/s11547-019-01042-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To report on the safety and clinical benefit of robotic stereotactic radiotherapy (SBRT) for liver oligometastatic colorectal cancer (CRC). METHODS Robotic SBRT was applied to oligometastatic CRC patients, defined as having 1-4 liver metastases and absent or controlled extrahepatic disease. The intended prescription dose was 37.5 Gy in three fractions. Treatment efficacy was estimated by clinical benefit rate (CBR), progression-free survival (PFS) and overall survival (OS). Toxicity was graded according to CTC-AE scale, v. 4.03. Regression analysis was performed to search for the presence of any predictive factors. RESULTS Between 2012 and 2017, 38 patients (66 lesions) were irradiated. The median delivered biological effective maximum dose (maxBED10) was 142 Gy. At a median follow-up of 11.8 months (range 3.2-58.8), the 1- and 2-year OS were 67.3% and 44.1%, respectively. Actuarial LC rates for all patients at 6 and 12 months were 64.2% and 60.4%, respectively. Local or distant progression occurred in 28 (77.8%) patients, with a 1- and 2-year PFS of 19.3% and 12.2%, respectively. The CBR was 71.4%, with no significant association with maxBED10. At multivariate analysis, the presence of extrahepatic disease had a detrimental impact on PFS (HR 3.98, 95% CI 1.77-8.93; p < 0.001) and OS (HR 3.58, 95% CI 1.06-12.07; p < 0.04). No acute grade 3 gastrointestinal toxicity was observed. CONCLUSIONS Our analysis underlines the importance of patients' selection to identify the oligometastatic scenario most likely to benefit from SBRT. Prospective studies are needed to further assess its role among locoregional treatment options for liver metastases from CRC.
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Onal C, Guler OC, Yildirim BA. Treatment outcomes of breast cancer liver metastasis treated with stereotactic body radiotherapy. Breast 2018; 42:150-156. [DOI: 10.1016/j.breast.2018.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/30/2018] [Accepted: 09/22/2018] [Indexed: 01/22/2023] Open
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Ihnát P, Skácelíková E, Tesař M, Penka I. Stereotactic body radiotherapy using the CyberKnife ® system in the treatment of patients with liver metastases: state of the art. Onco Targets Ther 2018; 11:4685-4691. [PMID: 30127616 PMCID: PMC6091471 DOI: 10.2147/ott.s165878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The management of patients with liver metastases presents a challenging problem in clinical oncology. Patients with limited involvement of the liver may be suitable for surgical resection or local ablative techniques. Stereotactic body radiotherapy (SBRT) presents an emerging new technology that has shown high efficacy in ablating tumors at various disease sites. Methods A comprehensive literature search was performed to identify articles in regard to the SBRT in the treatment of patients with liver metastases. Results SBRT allows for the delivery of high-dose radiation in few fractions to the tumor with extreme accuracy, while minimizing the damage to normal surrounding tissue. The CyberKnife® system is an image-guided robotic system that delivers SBRT, tracks tumors during respiration, and automatically adjusts treatment for any patient movement. The most frequently used indications for CyberKnife® therapy are ≤5 liver metastases with maximum tumor sizes of 6 cm, no extrahepatic disease, good performance status, and adequate hepatic functions. Local control rates range from 70%-100% at 1 year and from 60%-90% at 2 years. Severe toxicity related to SBRT is uncommon - grade three side effects occur in less than 5% of cases. Despite excellent local control rates, out-of-field metastatic progression (out-of-field hepatic metastases and extrahepatic metastases) develops in a substantial proportion of patients after SBRT. Therefore, it seems essential to improve the selection of patients with liver metastases for SBRT. Conclusion The CyberKnife® system presents an effective minimally invasive treatment modality for patients with hepatic oligometastases who are not suitable candidates for radical liver resection. The available data suggest that liver metastases can be treated by CyberKnife therapy with very low toxicity and excellent local control rates.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Eva Skácelíková
- Department of Oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Milan Tesař
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
| | - Igor Penka
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic, .,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic,
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Gill S, Liu DM, Green HM, Sharma RA. Beyond the Knife: The Evolving Nonsurgical Management of Oligometastatic Colorectal Cancer. Am Soc Clin Oncol Educ Book 2018; 38:209-219. [PMID: 30231355 DOI: 10.1200/edbk_200941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In patients with liver-limited oligometastatic disease, the goal of treatment can be curative intent. Historically, this was accomplished in patients presenting with upfront resectable disease. The availability of increasingly efficacious chemotherapy and biologic combinations with encouraging response rates led to the potential to convert unresectable disease to resectability. Beyond the backbone of surgery, we now have a portfolio of locoregional strategies to consider.From an interventional radiology perspective, the use of portal vein embolization can facilitate hypertrophy of the liver in anticipation of resection, thus converting unresectable disease to one amenable to a surgical approach with curative intent. Technological advances in liver-directed ablative therapies have afforded the possibility of eliminate radiographically evident disease with the hope for long-term disease control. Advanced radiotherapy techniques are further increasing the therapeutic options for patients with metastatic colorectal cancer. Improvements in external-beam radiotherapy over the past 2 decades include image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy, and proton-beam therapy. Finally, selective internal radiation therapy (SIRT) with microspheres labeled with the β-emitter 90Y enable targeted delivery of radiation to hepatic tumors. A coordinated multidisciplinary approach is required to integrate these nonsurgical adjuncts in an evidence-based manner to optimize outcomes for patients with potentially resectable metastatic disease. In this article, we summarize recent developments in systemic therapy, radiotherapy, and interventional liver-directed therapies that have changed the treatment landscape for patients with oligometastatic colorectal cancer.
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Affiliation(s)
- Sharlene Gill
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - David M Liu
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Harshani M Green
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Ricky A Sharma
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
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