Stereotactic body radiation therapy: an ablative treatment option for primary and secondary liver tumors.
Fuss M, Thomas CR Jr.
Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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Only a subset of patients with primary and secondary liver tumors are eligible for surgical resection because of either the presence of extrahepatic disease, increased number of hepatic lesions, the anatomical distribution of tumors within the liver, and/or general medical inoperability. Nonsurgical, ablative tumor treatment may benefit selected patients by preserving normal liver function. This review presents the concept and technology of stereotactic body radiation therapy and summarizes available clinical data describing applications in the treatment of malignant liver tumors. We present predominantly peer-reviewed data but also summarize recent clinical developments along with discussions of current ongoing and planned multicenter studies.
PMID: 14761915 [PubMed - in process]
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Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment.
Mageras GS, Yorke E.
We examine 2 strategies for reducing respiration-induced organ motion in radiation treatment: deep inspiration breath hold (DIBH) and respiratory gating. DIBH is a controlled breathing technique in which the patient performs a supervised breath hold during treatment. The technique offers 2 benefits: reduced respiratory motion from the breath hold and increased normal tissue sparing from the increased lung volume. In respiratory-gated treatment, a device external to the patient monitors breathing and allows delivery of radiation only during certain time intervals, synchronous with the patient's respiratory cycle. Gated treatment offers reduced respiratory motion with less patient effort than DIBH. We briefly survey the development of these 2 strategies, describe their clinical implementation for treatment of thoracic and liver tumors at the Memorial Sloan-Kettering Cancer Center, and discuss their advantages and limitations.
PMID: 14752734 [PubMed - in process]
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Radiosurgery for recurring liver metastases after hepatectomy.
Gunven P, Blomgren H, Lax I.
Department of Oncology, Radiumhemmet, Karolinska Hospital, SE 171 76 Stockholm, Sweden.
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BACKGROUND/AIMS: Most resected liver metastases from colorectal cancer recur. A minority of liver recurrences have been re-resected, but most re-resections fail and they decrease the postoperative performance status for a longer time than the initial resections, so that less demanding potentially curative treatments need evaluation. METHODOLOGY: Four out of 5 liver-only recurrences after 18 consecutive liver resections were limited and suitable for radiosurgery. The patients were fixed in a frame and stereotactic irradiation with 20 Gy twice or 15 Gy three times was delivered to the tumors. RESULTS: Limited side effects were seen, without medical need for hospital admission. Thirteen--101 months later, all treated tumors were locally controlled with complete radiologic remission of two of them. Only one patient recurred in the liver, with bilobar lesions preceded by extrahepatic spread. Neither recurrence would have been prevented by a rehepatectomy instead of irradiation. One patient died later tumor-free from stroke, two died from generalized tumors, and one remains in remission 101 months after radiosurgery. CONCLUSIONS: Radiosurgery of liver tumors merits further study, and may offer a less demanding alternative to resection for selected liver tumors with the prospect of long-term survival.
PMID: 14571698 [PubMed - indexed for MEDLINE]
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Stereotactic radiotherapy of targets in the lung and liver.
Wulf J, Hadinger U, Oppitz U, Thiele W, Ness-Dourdoumas R, Flentje M.
Department of Radiotherapy, University of Wuerzburg, Germany.
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BACKGROUND: Stereotactic irradiation of extracranial targets offers a non-invasive treatment modality for patients with localized tumors, which are not amenable for surgery or other invasive approaches because of age or impaired medical condition. The purpose of the study was the evaluation of the method to achieve local control of irradiated targets in relation to treatment toxicity. PATIENTS AND METHODS: Irradiation was performed as hypofractionated treatment in three fractions of 10 Gy each, normalized to the PTV enclosing 65% isodose with patient fixation in a stereotactic body frame. The isocenter was localized by stereotactic coordinates. Targets were circumscribed tumors in the lung (n = 27) and liver (n = 24) not amenable for other treatment modalities: primary lung cancer (n = 12), local recurrences of lung cancer (n = 4), lung metastases (n = 11), liver metastases (n = 23) and one cholangiocellular carcinoma. Median CTV/PTV for targets in the lung was 57/113 cm3 (min/max 5-277 cm3/17-343 cm3) and for targets in the liver 50/102 cm3 (min/max 9-516 cm3/42-772 cm3). Median follow-up for targets in the lung was 8 months (2-33) and 9 months (2-28) for liver targets. Local control was defined as complete or partial remission and stable disease, measured by repeated CT scans after 6 weeks and in 3 months intervals. Treatment toxicity was evaluated according to the WHO score. RESULTS: Crude local control was 85% for pulmonary targets and 83% for hepatic targets. Actuarial local control after 1 and 2 years was 76% and 76% for lung tumors and 76% and 61% for liver tumors. Actuarial overall patient survival was 48% after 1 year and 21% after 2 years for targets in the lung and 71% and 43% for targets in the liver. No acute grade 3-5 side effects were observed. Serious late toxicity occurred in two patients: a chronic ulceration of the esophagus at a target close to the mediastinum after 3 months (grade 3) and fatal bleeding from the pulmonary artery after 9 months (grade 5) in a previously irradiated patient. It remained unclear, whether the bleeding was a side effect of irradiation or due to tumor infiltration. CONCLUSION: Hypofractionated stereotactic irradiation of targets in the lung and liver is a locally effective treatment with actuarial local control rates of 76% after 1 year and 61-76% after 2 years without relevant acute toxicity. Severe late toxicity did not occur, if targets close to the mediastinum were avoided.
PMID: 11789403 [PubMed - indexed for MEDLINE]
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Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial.
Herfarth KK, Debus J, Lohr F, Bahner ML, Rhein B, Fritz P, Hoss A, Schlegel W, Wannenmacher MF.
Division of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
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PURPOSE: To investigate the feasibility and the clinical response of a stereotactic single-dose radiation treatment for liver tumors. PATIENTS AND METHODS: Between April 1997 and September 1999, a stereotactic single-dose radiation treatment of 60 liver tumors (four primary tumors, 56 metastases) in 37 patients was performed. Patients were positioned in an individually shaped vacuum pillow. The applied dose was escalated from 14 to 26 Gy (reference point), with the 80% isodose surrounding the planning target volume. Median tumor size was 10 cm(3) (range, 1 to 132 cm(3)). The morbidity, clinical outcome, laboratory findings, and response as seen on computed tomography (CT) scan were evaluated. RESULTS: Follow-up data could be obtained from 55 treated tumors (35 patients). The median follow-up period was 5.7 months (range, 1.0 to 26.1 months; mean, 9.5 months). The treatment was well tolerated by all patients. There were no major side effects. Fifty-four (98%) of 55 tumors were locally controlled after 6 weeks at the initial follow-up based on the CT findings (22 cases of stable disease, 28 partial responses, and four complete responses). After a dose-escalating and learning phase, the actuarial local tumor control rate was 81% at 18 months after therapy. A total of 12 local failures were observed during follow-up. So far, the longest local tumor control is 26.1 months. CONCLUSION: Stereotactic single-dose radiation therapy is a feasible method for the treatment of singular inoperable liver metastases with the potential of a high local tumor control rate and low morbidity.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase I
- Clinical Trial, Phase II
PMID: 11134209 [PubMed - indexed for MEDLINE]
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