Stereotactic radiotherapy of primary liver cancer and hepatic metastases

Wulf, Joern; Gückenberger, Matthias; Haedinger, Ulrich; Oppitz, Ulrich; Mueller, Gerd; Baier, Kurt; Flentje, Michael

doi:10.1080/02841860600904821

Cited by 244 publications

(159 citation statements)

References 27 publications

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…32,33 Multiple studies of liver stereotactic body radiotherapy have been reported showing local control rates ranging from 65% to 95% at 1 to 2 years. [5][6][7][8][9][10] Indeed, problems arise when comparing stereotactic body radiotherapy studies because of patient and treatment heterogeneity. Referral patterns and selection criteria are different at each institution and, because these early studies included numerous tumor histologies, the results are difficult to apply to management of colorectal metastases.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for colorectal liver metastases

Chang

Swaminath

Kozak

et al. 2011

Cancer

267

View full text Add to dashboard Cite

BACKGROUND: This study was undertaken to determine outcomes of stereotactic body radiotherapy for colorectal liver metastases in a pooled patient cohort. METHODS: Patients with colorectal liver metastases from 3 institutions were included if they had 1 to 4 lesions, received 1 to 6 fractions of stereotactic body radiotherapy, and had radiologic imaging 3 months post-treatment. Sixty-five patients with 102 lesions treated from August 2003 to May 2009 were retrospectively analyzed. A tumor control probability (TCP) model was used to estimate the 3-fraction dose required for >90% local control after converting the schedule into biologically equivalent dose (BED), single-fraction equivalent dose, or linear quadratic model-based single-fraction dose. RESULTS: Forty-seven (72%) patients had 1 chemotherapy regimen before stereotactic body radiotherapy, and 27 (42%) patients had 2 regimens. The median followup was 1.2 years (range, 0.3-5.2 years). The median dose was 42 gray (Gy; range, 22-60 Gy). When evaluated separately by multivariate analysis, total dose (P ¼ .0015), dose/fraction (P ¼ .003), and BED (P ¼ .004) all correlated with local control by lesion. On multivariate analysis, nonactive extrahepatic disease was associated with overall survival (OS; P ¼ .046), and sustained local control was closely correlated (P ¼ .06). By using single-fraction equivalent dose, BED, or linear quadratic model-based single-fraction dose in the TCP model, the estimated dose range needed for 1-year local control >90% is 46 to 52 Gy in 3 fractions. CONCLUSIONS: Liver stereotactic body radiotherapy is well tolerated and effective for colorectal liver metastases. The strong correlation between local control and OS supports controlling hepatic disease even for heavily pretreated patients. For a 3-fraction regimen of stereotactic body radiotherapy, a prescription dose of 48 Gy should be considered, if normal tissue constraints allow. Cancer 2011;117:4060-

show abstract

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for colorectal liver metastases

Chang

Swaminath

Kozak

et al. 2011

Cancer

267

View full text Add to dashboard Cite

show abstract

“…23 The team from Wurzburg found a 2-year local control of 82 vs. 58% after delivering 36-37.5 Gy in 3 fractions or 26 Gy in 1 fraction vs. 30 Gy in 3 fractions. 7 Later on, in the North American multiinstitutional phase I/II study, the dose was escalated from 36 to 60 Gy with reported 2 years local control rate of 92%. From the same authors group, a dose of at least 54 Gy in 3 fractions had been proposed to achieve 89% local control at 3 years for targets in lung and liver.…”

Section: Discussionmentioning

confidence: 99%

“…In 2006 Wulf et al found a significant improvement in 2 year local control (82 vs. 58%) with 12-12.5 Gy in 3 fractions or 26 Gy in 1 fraction vs. 30 Gy in 3 fractions. 7 No severe toxicity was observed. Later on, in a multi-institutional phase I/II study, Rusthoven et al evaluated the efficacy and tolerability of high dose SBRT.…”

Section: Introductionmentioning

confidence: 95%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

View full text Add to dashboard Cite

Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

show abstract

“…The biological effective dose (BED) was also calculated (29) using the DVH‐based approach:

{BED}_{i} = n d_{i} [1 + \frac{d_{i}}{false(α / β false)}] false(Gy false)

where

n = the number of fractions

d_{i} = the dose per fraction in bin i of the DVH

, and the value

α / β = 2

Gy was used for late toxicity in the normal liver (30) and the commonly used value

α / β = 10

Gy was applied for the tumor (31) …”

Section: Methodsmentioning

confidence: 99%

Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration

Yeo

Taylor

Supple

et al. 2014

J Applied Clin Med Phys

View full text Add to dashboard Cite

The purpose of this study is to evaluate dosimetric errors in 3D conventional planning of stereotactic body radiotherapy (SBRT) by using a 4D deformable image registration (DIR)‐based dose‐warping and integration technique. Respiratory‐correlated 4D CT image sets with 10 phases were acquired for four consecutive patients with five liver tumors. Average intensity projection (AIP) images were used to generate 3D conventional plans of SBRT. Quasi‐4D path‐integrated dose accumulation was performed over all 10 phases using dose‐warping techniques based on DIR. This result was compared to the conventional plan in order to evaluate the appropriateness of 3D (static) dose calculations. In addition, we consider whether organ dose metrics derived from contours defined on the average intensity projection (AIP), or on a reference phase, provide the better approximation of the 4D values. The impact of using fewer (<10) phases was also explored. The AIP‐based 3D planning approach overestimated doses to targets by 1.4% to 8.7% (mean 4.2%) and underestimated dose to normal liver by up to 8% (mean −5.5%; range −2.3% to −8.0%), compared to the 4D methodology. The homogeneity of the dose distribution was overestimated when using conventional 3D calculations by up to 24%. OAR doses estimated by 3D planning were, on average, within 10% of the 4D calculations; however, differences of up to 100% were observed. Four‐dimensional dose calculation using 3 phases gave a reasonable approximation of that calculated from the full 10 phases for all patients, which is potentially useful from a workload perspective. 4D evaluation showed that conventional 3D planning on an AIP can significantly overestimate target dose (ITV and GTV+5mm), underestimate normal liver dose, and overestimate dose homogeneity. Implementing nonadaptive quasi‐4D dose calculation can highlight the potential limitation of 3D conventional SBRT planning and the resultant misrepresentations of dose in some regions affected by motion and deformation. Where the 4D approach is unavailable, contouring on the full expiration phase may yield more accurate dose calculations, most relevant in the case of the healthy liver, but the absolute dose differences are in general small for the other healthy organs. The technique has the potential to quantify under‐ and over‐dosage and improve treatment plan evaluation, retrospective plan analysis, and clinical outcome correlation.PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.de, 87.55.dk, 87.55.Qr, 87.57.nj

show abstract

Stereotactic radiotherapy of primary liver cancer and hepatic metastases

Cited by 244 publications

References 27 publications

Stereotactic body radiotherapy for colorectal liver metastases

Stereotactic body radiotherapy for colorectal liver metastases

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration

Contact Info

Product

Resources

About