Stereotactic Body Radiation Therapy for Liver Metastases and Primary Hepatocellular Carcinoma: Normal Tissue Tolerances and Toxicity

Sawrie, Stephen M.; Fiveash, John B.; Caudell, Jimmy J.

doi:10.1177/107327481001700206

Cited by 44 publications

(21 citation statements)

References 24 publications

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“…Stereotactic body radiotherapy allows delivery of ablative doses of radiation to metastatic lesions. The efficacy and tolerability of SBRT for liver metastasis has been confirmed by retrospective studies [23][24][25][26] showing local control rates around 80% or higher [27]. At Centre Oscar Lambret, 42 patients with 62 liver metastases were treated with SBRT at 40 Gy in 4 fractions and 45 Gy in 3 fractions.…”

Section: Biological Basis Of the Oligometastatic Phenotypementioning

confidence: 93%

Oligometastasis and oligo-recurrence: more than a mirage

Huang

2014

Radiation Oncology

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The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging evidence has shown an oligometastatic state, an intermediate state between limited primary cancer and polymetastatic cancer, in which local therapy for metastatic lesions results in satisfactory survival comparable to non-metastatic disease. We provide a comprehensive introduction of evidence from experimental and clinical studies in favor of the oligometastatic phenotype, we review the efficacy and safety of surgery and stereotactic body radiotherapy in the treatment of oligometastases, and finally, we discuss the way to differentiate the oligometastatic state from polymetastasis.

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Section: Biological Basis Of the Oligometastatic Phenotypementioning

confidence: 93%

Oligometastasis and oligo-recurrence: more than a mirage

Huang

2014

Radiation Oncology

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“…The dose required for a favorable result of the radiotherapy treatment might be 24-30 Gy in a single dose, 45-60 Gy in 3 fractions, 40-50 Gy in 5 fractions, 48-60 Gy in 6 fractions. 1,10,18,23,24 …”

Section: Dosementioning

confidence: 99%

“…In terms of radiobiology, the signification of doses is different for stomach (alpha/beta 5) and for bowel (alpha/beta 8). 1 For stomach, the proposed constraints in various studies range from 7 to 30 Gy maximum dose with a BED of 10.3-90 Gy 5 . 1,3,4,17,28 Mendez Romero et al constrained 5 cc of stomach to less than 21 Gy.…”

Section: Stomach Duodenal and Bowel Toxicitiesmentioning

confidence: 99%

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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“…Still, Katz et al [11] reported no RILD at normal liver volume ≥1,000 mL and mean dose <15 Gy (50 Gy/ 10 fractions). Therefore, at least 700 mL of normal liver (Child-Pugh A) must receive <15 Gy to minimize acute and late liver toxicities [15]. …”

Section: Radiation Dosementioning

confidence: 99%

Consensus on Stereotactic Body Radiation Therapy for Small-Sized Hepatocellular Carcinoma at the 7th Asia-Pacific Primary Liver Cancer Expert Meeting

et al. 2017

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Background: Stereotactic body radiation therapy (SBRT) is an advanced technique of external beam radiation therapy that delivers large ablative doses of radiation. In the past decade, many cancer centers have adopted SBRT as one mode of radically treating small-sized hepatocellular carcinoma (HCC), based on encouraging clinical outcomes. SBRT thus seems reasonable as first-line treatment of inoperable HCC confined to the liver. However, most of the clinical studies to date have been retrospective in nature, with key issues still under investigation. Summary: The above-mentioned publications were subjected to scrutiny, fueling discussions at the 7th Asia-Pacific Primary Liver Cancer Expert (APPLE 2016) Meeting on various clinical variables, such as indications for SBRT, therapeutic outcomes, treatment-related toxicities, doses prescribed, and specific techniques. The consensus reached should be of interest to all professionals active in the treatment of HCC, especially radiation oncologists. Key Messages: SBRT is a safe and effective therapeutic option for patients with small-sized HCC, offering substantial local control, improved overall survival, and low toxicity.

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Stereotactic Body Radiation Therapy for Liver Metastases and Primary Hepatocellular Carcinoma: Normal Tissue Tolerances and Toxicity

Cited by 44 publications

References 24 publications

Oligometastasis and oligo-recurrence: more than a mirage

Oligometastasis and oligo-recurrence: more than a mirage

Dose to organ at risk and dose prescription in liver SBRT

Consensus on Stereotactic Body Radiation Therapy for Small-Sized Hepatocellular Carcinoma at the 7th Asia-Pacific Primary Liver Cancer Expert Meeting

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