Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

Liu, Erqi; Stenmark, Matthew H.; Schipper, Matthew J.; Balter, James M.; Kessler, Marc L.; Caoili, Elaine M.; Lee, Oliver E.; Ben‐Josef, Edgar; Lawrence, Theodore S.; Feng, Mary

doi:10.1593/tlo.12448

Cited by 52 publications

(30 citation statements)

References 18 publications

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“…SBRT has the ability to concentrate the radiation dose to a confined anatomical area over a shorter number of fractions and to minimize adjacent toxicities. Our center has been a forerunner in the use of SBRT for a variety of hepatic malignancies, and it has been shown to be safe and effective, even in the presence of underlying liver disease . Therefore, we sought to build on this experience by using a combination of SBRT (in 5 fractions or fewer) and subsequent oral capecitabine for the neoadjuvant treatment of patients with unresectable hilar CCA before transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…After radiation therapy, chemotherapy has traditionally been based on a 5‐fluorouracil infusion followed by capecitabine. Our center has developed the novel use of stereotactic body radiation therapy (SBRT) in the treatment of hepatic malignancies . Safety and efficacy have been demonstrated for these cancers often in many patients with underlying liver disease or cirrhosis .…”

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confidence: 99%

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Neoadjuvant stereotactic body radiation therapy, capecitabine, and liver transplantation for unresectable hilar cholangiocarcinoma

et al. 2013

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Hilar cholangiocarcinoma (CCA) is a difficult malignancy to treat surgically given its anatomical location and its frequent association with primary sclerosing cholangitis (PSC). Neoadjuvant chemoradiotherapy followed by liver transplantation in lymph node negative patients has been advanced by select liver transplant centers for treatment of patients with unresectable disease. This approach has most commonly used external beam radiotherapy combined with biliary brachytherapy and 5-FU based chemotherapy. Our center has recently embarked on a protocol utilizing stereotactic body radiation therapy (SBRT) followed by capecitabine in lymph node negative patients until liver transplantation. We therefore retrospectively determined tolerability and pathologic response in this pilot study. Over a three year period 17 patients with unresectable hilar CCA were evaluated for treatment under this protocol. In all, 12 patients qualified for neoadjuvant therapy and were treated with SBRT (50–60 Gy, 3–5 fractions over two weeks). Following one week of rest, capecitabine was initiated at 1330 mg/m2/day and continued until liver transplantation. During neoadjuvant therapy, there were a total of 35 adverse events with cholangitis and palmar/plantar erythrodysesthesia being the most common. Capecitabine dose reductions were required on 5 occasions. Ultimately, 9 patients were listed for transplant and 6 patients received a liver transplant. Explant pathology of hilar tumors showed at least a partial treatment response in five patients with extensive tumor necrosis and fibrosis noted. Additionally, high apoptotic and low proliferative indices were measured on histological examination. Eleven transplant-related complications occurred, and one-year survival after transplant was 83%. In this pilot study, neoadjuvant therapy with SBRT, capecitabine, and liver transplantation for unresectable CCA demonstrated acceptable tolerability. Further studies will determine the overall future efficacy of this therapy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Neoadjuvant stereotactic body radiation therapy, capecitabine, and liver transplantation for unresectable hilar cholangiocarcinoma

et al. 2013

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“…[3,10] Stereotactic body radiation therapy (SBRT) is becoming an emerging and effective treatment paradigm in radiation therapy to treat early stage non-small cell lung cancer and liver cancer patients with promising early clinical outcome. [6,14,16,17] Compared to traditional fractionated radiotherapy, SBRT delivers much higher radiation dose per fraction in one to five fractions. On-board 4D or real time volumetric verification of the target location before and during the treatment is critical for lung and liver SBRT treatments due to its tight PTV margin, high fractional dose and long treatment time.…”

Section: Introductionmentioning

confidence: 99%

A Technique for Generating Volumetric Cine-Magnetic Resonance Imaging

Harris

Ren

Cai

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose To develop a technique to generate on-board volumetric-cine MRI (VC-MRI) using patient prior images, motion modeling and on-board 2D-cine MRI. Methods One phase of a 4D-MRI acquired during patient simulation is used as patient prior images. 3 major respiratory deformation patterns of the patient are extracted from 4D-MRI based on principal-component-analysis. The on-board VC-MRI at any instant is considered as a deformation of the prior MRI. The deformation field is represented as a linear combination of the 3 major deformation patterns. The coefficients of the deformation patterns are solved by the data fidelity constraint using the acquired on-board single 2D-cine MRI. The method was evaluated using both XCAT simulation of lung cancer patients and MRI data from four real liver cancer patients. The accuracy of the estimated VC-MRI was quantitatively evaluated using Volume-Percent-Difference(VPD), Center-of-Mass-Shift(COMS), and target tracking errors. Effects of acquisition orientation, region-of-interest(ROI) selection, patient breathing pattern change and noise on the estimation accuracy were also evaluated. Results Image subtraction of ground-truth with estimated on-board VC-MRI shows fewer differences than image subtraction of ground-truth with prior image. Agreement between profiles in the estimated and ground-truth VC-MRI was achieved with less than 6% error for both XCAT and patient data. Among all XCAT scenarios, the VPD between ground-truth and estimated lesion volumes was on average 8.43±1.52% and the COMS was on average 0.93±0.58mm across all time-steps for estimation based on the ROI region in the sagittal cine images. Matching to ROI in the sagittal view achieved better accuracy when there was substantial breathing pattern change. The technique was robust against noise levels up to SNR=20. For patient data, average tracking errors were less than 2 mm in all directions for all patients. Conclusions Preliminary studies demonstrated the feasibility to generate real-time VC-MRI for on-board localization of moving targets in radiotherapy.

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“…Several studies over the past 10 years have demonstrated that SBRT can safely and effectively treat liver tumors up to 6 cm in size with local control rates higher than 80% to 90%. [9][10][11][12][13][14][15][16] The treatment of liver tumors with SBRT, however, is often limited by liver dose constraints aimed at minimizing the risk of radiation-induced liver disease (RILD). It is generally accepted in the surgical literature that 75% to 80% of a 2000-mL noncirrhotic liver can be safely resected.…”

Section: Introductionmentioning

confidence: 99%

Clinical decision tool for optimal delivery of liver stereotactic body radiation therapy: Photons versus protons

Gandhi

Lü

Ding

et al. 2015

Practical Radiation Oncology

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Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

Abstract: SBRT provides excellent local control for both primary and metastatic liver lesions with minimal toxicity. Future studies should focus on appropriate selection of patients and on careful assessment of liver function to maximize both the safety and efficacy of treatment.

Cited by 52 publications

References 18 publications

Neoadjuvant stereotactic body radiation therapy, capecitabine, and liver transplantation for unresectable hilar cholangiocarcinoma

Neoadjuvant stereotactic body radiation therapy, capecitabine, and liver transplantation for unresectable hilar cholangiocarcinoma

A Technique for Generating Volumetric Cine-Magnetic Resonance Imaging

Clinical decision tool for optimal delivery of liver stereotactic body radiation therapy: Photons versus protons

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