Stereotactic Robotic Body Radiotherapy for Patients With Unresectable Hepatic Oligorecurrence

Berkovic, P.; Gulybán, Ákos; Nguyen, Paul Viet; Dechambre, D.; Martinive, Philippe; Jansen, Nicolas; Lakosi, Ferenc; Janvary, L.; Coucke, Philippe

doi:10.1016/j.clcc.2017.03.006

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…Üblicherweise werden heute 5 oder weniger Metastasen in bis zu 3 verschiedenen Organen als Oligometastasierung klassifiziert, obwohl diese Definition in Bezug auf die Tumordynamik sowie die klinischen und biologische Hintergründe immer noch sehr aktiv diskutiert wird. Vom Stadium der Oligometastasierung ist das Stadium der Oligorekurrenz [5] und der Oligoprogression [6] zu unterscheiden. Diese Stadien beschreiben einen Zustand, in dem eine Metastasierung unter systemischer Therapie generell kontrolliert ist, jedoch vereinzelt neue Metastasen entstehen (Oligorekurrenz) oder einzelne existierende Metastasen progredient sind (Oligoprogression).…”

Section: Stereotaktische Strahlentherapie Für Lebermetastasen Stereotunclassified

“…Diese Stadien beschreiben einen Zustand, in dem eine Metastasierung unter systemischer Therapie generell kontrolliert ist, jedoch vereinzelt neue Metastasen entstehen (Oligorekurrenz) oder einzelne existierende Metastasen progredient sind (Oligoprogression). Auch hier kann eine fokussierte Lokaltherapie indiziert sein [5,6]. Diese Erkrankungssituationen sind klinisch weitaus schlechter untersucht, nicht zuletzt, weil viele Autoren auch diese unter der Oligometastasierung subsumieren.…”

Section: Stereotaktische Strahlentherapie Für Lebermetastasen Stereotunclassified

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Stereotaktische Strahlentherapie für Lebermetastasen

et al. 2019

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ZusammenfassungIn dieser Übersichtsarbeit wird der aktuelle Stand der stereotaktischen Strahlentherapie im Bereich des Körperstamms (SBRT) als Lokaltherapie für Patienten mit Lebermetastasen im Zustand der Oligometastasierung, Oligoprogression und Oligorekurrenz mit Fokus auf aktuelle Publikationen aus dem deutschsprachigen Raum dargelegt. Moderne SBRT-Techniken umfassen heute neben der präzisen Bildgebung auch Gating- und Tracking-Techniken, welche die Lokaltherapie von Lebermetastasen effektiver gemacht haben. Damit und mit zentralen Tumordosisoptimierungen lassen sich hohe lokale Kontrollraten von langfristig bis über 90% erreichen, die mit minimalen schweren Nebenwirkungsraten von unter 1% und 5-Jahres-Überlebensraten von mehr als 30% in selektionierten (inoperablen) Patientenkollektiven einhergehen. Durch hybride Ultraschall- oder MRT-Bestrahlungssysteme kann zukünftig die teils aktuell technisch erforderliche Fiducial-Marker-Implantation überwunden werden. Die SBRT stellt aufgrund der aktuellen Ergebnislage für Patienten mit Lebermetastasen eine wertvolle Ergänzung des therapeutischen Armamentariums als ebenbürtige Alternative zu minimalinvasiven ablativen Verfahren oder in Kombination mit anderen lokalen oder systemischen Behandlungen im interdisziplinären Kontext dar.

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Section: Stereotaktische Strahlentherapie Für Lebermetastasen Stereotunclassified

Stereotaktische Strahlentherapie für Lebermetastasen

et al. 2019

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“…Although the standard dose for primary rectal cancer is generally 45 to 54 Gy in 1.8-Gy fractions daily, some investigators report that hepatic metastases from CRC are more radioresistant than other liver metastases clinically. 40,41 SBRT can potentially allow delivery of higher biologic doses of radiotherapy than conventional fractionation in three to five fractions over 2 weeks, with greater convenience for patients and potentially higher efficacy than conventional radiotherapy. It requires very accurate image guidance and motion management to ensure a high degree of spatial accuracy.…”

Section: Radiotherapy For Oligometastases: Advances In External Beam mentioning

confidence: 99%

Beyond the Knife: The Evolving Nonsurgical Management of Oligometastatic Colorectal Cancer

Gill

Liu

Green

et al. 2018

American Society of Clinical Oncology Educational Book

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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 Y 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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“…Previously published OAR dose constraints during liver SBRT were used. [12,19] At least 700 mL of healthy liver should receive <15 Gy in three fractions. Other dose constraints of OARs included total kidney volume <15 Gy (volume receiving 15 Gy should be <35%), maximum dose (D1cc) for spinal cord <18 Gy, D1cc for duodenum <21 Gy, D1cc for small bowel <21 Gy, D1cc for esophagus <21 Gy, D1cc for stomach <21 Gy, D1cc for heart <30 Gy, and D1cc for ribs <30 Gy.…”

Section: Sbrt Techniquementioning

confidence: 99%

Prognostic Value of Metabolic Response Measured by FDG-PET-CT in Patients with Breast Cancer Liver Metastasis Treated with Stereotactic Body Radiotherapy

Güler¹

2018

TJ Oncol

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OBJECTIVETo investigate the impact of metabolic response measured by 18-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET-CT) in patients with breast cancer liver metastasis (BCLM) treated with stereotactic body radiotherapy (SBRT). METHODSThe medical records of 17 patients with BCLM treated with SBRT between March 2013 and October 2017 were investigated retrospectively. Patients received SBRT for their liver metastasis, and thereafter, a second FDG-PET-CT was performed for response assessment in a median of 4.1 (2.2-8.2) months. A total of 54 Gy in three fractions were delivered to liver metastatic lesions. The standardized uptake value (SUV) and survival rates were evaluated. RESULTSAfter a median follow-up time of 11.5 (3.2-48.9) months, there was a significant difference between preand post-SBRT SUVs (p<0.001). Complete metabolic response was observed in 14 (82%) patients, partial metabolic response was observed in 2 (12%) patients, and stable metabolic disease/progressive metabolic disease was observed in 1 (6%) patient at post-treatment PET-CT. The 1-and 2-year overall survival rates were 68% and 57%, respectively, and the 1-and 2-year progression-free survival rates were 38% and 25%, respectively. CONCLUSIONPET-CT is an effective tool for response monitoring in patients with BCLM treated with SBRT.

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Stereotactic Robotic Body Radiotherapy for Patients With Unresectable Hepatic Oligorecurrence

Abstract: Favorable survival and toxicity results support the potential paradigm shift in which the use of SBRT in oligorecurrent liver disease could benefit patients with unresectable or resectable liver metastases.

Cited by 18 publications

References 38 publications

Stereotaktische Strahlentherapie für Lebermetastasen

Stereotaktische Strahlentherapie für Lebermetastasen

Beyond the Knife: The Evolving Nonsurgical Management of Oligometastatic Colorectal Cancer

Prognostic Value of Metabolic Response Measured by FDG-PET-CT in Patients with Breast Cancer Liver Metastasis Treated with Stereotactic Body Radiotherapy

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