Predictors of Toxicity Associated With Stereotactic Body Radiation Therapy to the Central Hepatobiliary Tract

Osmundson, Evan C.; Wu, Yufan; Luxton, Gary; Bazan, Jose G.; Koong, Albert C.; Chang, Daniel T.

doi:10.1016/j.ijrobp.2014.11.028

Cited by 70 publications

(52 citation statements)

References 19 publications

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“…Consequently, gastrointestinal bleeding and severe right upper quadrant pain after chemoembolization have been previously documented, and the risk is increased in patients with preexisting liver failure or portal vein obstruction (6). Ascites and portal vein thrombosis have been cited as hepatobiliary complications (7,8). Therefore, our definition of hepatobiliary adverse events is supported by the literature.…”

Section: Drs Deipolyi Et Al Respondmentioning

confidence: 74%

Drs. Deipolyi et al respond:

Deipolyi¹,

Öklü²,

Al-Ansari³

et al. 2015

Journal of Vascular and Interventional Radiology

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Section: Drs Deipolyi Et Al Respondmentioning

confidence: 74%

Drs. Deipolyi et al respond:

Deipolyi¹,

Öklü²,

Al-Ansari³

et al. 2015

Journal of Vascular and Interventional Radiology

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“…29,31 The comparison of studies should take into account the treatment duration and the doses per fraction according to the quadratic linear model. 31,[35][36][37] The alpha/beta ratio for healthy liver is quite low, from 1.5 13 to 3 38 . Murphy et al 33 postulates that the risk of hepatic toxicity for hypofractionated irradiation is overestimated in clinical practice when biological normalization is omitted.…”

Section: Hepatic Functions and Tumor Type Classical Data Showmentioning

confidence: 98%

“…The 7 patients who received more than 20 Gy on the gallbladder did not present any toxicity. In another article, Osmundson et al 37 presented a population of 96 patients irradiated for primary or metastatic hepatic lesions treated between 2006 and 2013. The central biliary system was defined by the authors as a 15 mm expansion of the portal veina from the splenic convergence to the portal bifurcation.…”

Section: Biliary Tract Toxicitymentioning

confidence: 99%

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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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“…The threshold dose for biliary stricture is not well known, but some generalizations can be made from clinical observations. The use of SBRT in 3 to 5 fractions has caused high biliary stricture rates; thus, SBRT in 3 to 5 fractions should not be used anywhere near the common, right main, or left main hepatic ducts. Investigators at the University of Tsukuba reported 3 cases of biliary strictures after delivery of 79.2 cobalt gray equivalents (CGE) in 16 fractions (ie, 5.0 CGE per fraction); they subsequently changed that regimen to 72.6 CGE in 22 fractions (3.3 CGE per fraction) and observed no further strictures .…”

Section: Addressing the Challenges Of Irradiating Large Liver Tumorsmentioning

confidence: 99%

Solutions that enable ablative radiotherapy for large liver tumors: Fractionated dose painting, simultaneous integrated protection, motion management, and computed tomography image guidance

Crane

Koay

2016

Cancer

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The emergence and success of stereotactic body radiation therapy (SBRT) in lung cancer has led to its rapid adoption for liver cancers. SBRT can achieve excellent results for small liver tumors. However, the vast majority of physicians interpret SBRT as meaning doses of radiation (4 to 20 Gy) that may not be ablative, but are delivered within about 1 week (i.e., in 3 to 6 fractions). Adherence to this approach has limited the effectiveness of SBRT for large liver tumors (> 7 cm) owing to the need to reduce doses to meet organ constraints. The prognosis for patients who present with large liver tumors is poor with median survival times of 12 months or less, and most such patients die from tumor-related liver failure. Herein, we present a comprehensive solution to achieve stereotactic ablative body radiation (SABR) doses for patients with large liver tumors by using a combination of classical, modern, and novel concepts of radiotherapy: fractionation, dose painting, motion management, image guidance, and simultaneous integrated protection. We discuss these concepts in the context of large inoperable liver tumors and review how this approach can substantially prolong survival for patients, most of whom otherwise have a very poor prognosis and few effective treatment options.

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Predictors of Toxicity Associated With Stereotactic Body Radiation Therapy to the Central Hepatobiliary Tract

Cited by 70 publications

References 19 publications

Drs. Deipolyi et al respond:

Drs. Deipolyi et al respond:

Dose to organ at risk and dose prescription in liver SBRT

Solutions that enable ablative radiotherapy for large liver tumors: Fractionated dose painting, simultaneous integrated protection, motion management, and computed tomography image guidance

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