Local Control following Stereotactic Body Radiation Therapy for Liver Tumors

Publication date: Available online 6 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nitin Ohri, Wolfgang A. Tomé, Alejandra Méndez Romero, Moyed Mifften, Randall K. Ten Haken, Laura A. Dawson, Jimm Grimm, Ellen Yorke, Andrew Jackson
PurposeNumerous dosing and fractionation schedules have been used to treat hepatic tumors with stereotactic body radiation therapy (SBRT). In this report, we have quantitatively evaluated published experiences with hepatic SBRT to determine local control rates following treatment of primary and metastatic liver tumors and to examine if outcomes are affected by SBRT dosing regimen.MethodsWe identified published articles that reported local control rates following SBRT for primary or metastatic liver tumors. Biologically effective doses (BEDs) were calculated for each dosing regimen using the Linear Quadratic Equation. We excluded series in which a wide range of BEDs was used. Individual lesion data for local control were extracted from actuarial survival curves, and data were aggregated to form a single dataset. Actuarial local control curves were generated using the Kaplan-Meier method after grouping lesions by disease type and BED (<100 Gy10 v. >100 Gy10). Comparisons were made using logrank testing.ResultsThirteen papers met all inclusion criteria and formed the dataset for this analysis. One, two, and three-year actuarial local control rates following SBRT for primary liver tumors (n=431) were 93%, 89%, and 86%, respectively. Lower one (90%), two (79%), and three-year (76%) actuarial local control rates were observed for liver metastases (n=290, logrank p=0.011). Among patients treated with SBRT for primary liver tumors, there was no evidence that local control is influenced by BED within the range of schedules used. For liver metastases, on the other hand, outcomes were significantly better for lesions treated with BEDs exceeding 100 Gy10 (3-year local control 93%) than for those treated with BEDs less than or equal to 100 Gy10 (3-year local control 65%, p<0.001).ConclusionSBRT for primary liver tumors provides high rates of durable local control, with no clear evidence for a dose-response relationship among commonly-utilized schedules. Excellent local control rates are also seen following SBRT for liver metastases when biologically effective doses above 100 Gy10 are utilized.

Teaser

We have quantitatively evaluated published experiences with hepatic SBRT to determine local control rates for primary and metastatic liver tumors and have examined if outcomes are affected by SBRT dosing regimen. We found that for primary liver tumors SBRT provides high rates of durable local control, with no clear evidence of a dose-response relationship for commonly-utilized schedules. While for liver metastases following SBRT excellent local control rates are seen when utilizing biologically effective doses above 100 Gy10.


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