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Liver Metastasis

  • Chapter
Book cover Stereotactic Body Radiation Therapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

With its dual portal and arterial blood supply, the liver is a common site for metastatic disease. Traditionally the liver has been viewed as a difficult organ to irradiate due to both normal tissue constraints as well as organ motion. New devices for patient immobilization, better imaging techniques, and advanced treatment delivery methods such as stereotactic body radiation therapy (SBRT), have made radiation therapy a viable therapeutic option for liver metastases. Oligometastatic disease from several solid primary cancers is now considered a potentially curable state. As such, ablative therapies such as SBRT offer a non-invasive alternative to surgery and radiofrequency ablation (RFA). This chapter will review the technical and clinical aspects of SBRT for liver metastases.

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Abbreviations

SBRT:

Stereotactic body radiation therapy

RFA:

Radiofrequency ablation

PTV:

Planning target volume

GTV:

Gross tumor volume

CT:

Computed tomography

PET:

Positron emission tomography

CTV:

Clinical tumor volume

ITV:

Internal target volume

MRI:

Magnetic resonance imaging

DDR:

Digitally reconstructed radiograph

BED:

Biological equivalent dose

TACE:

Transarterial chemo-embolization

RILD:

Radiation induced liver disease

HCC:

Hepatocellular carcinoma

VOD:

Veno-occlusive disease

QUANTEC:

Quantitative analysis of normal tissue effect in the clinic

References

  • Ambrosino G, Polistina F, Costantin G, Francescon P, Guglielmi R, Zanco P, Casamassima F, Febbraro A, Gerunda G, Lumachi F (2009) Image-guided robotic stereotactic radiosurgery for unresectable liver metastases: preliminary results. Anticancer Res 29(8):3381–3384

    PubMed  Google Scholar 

  • Balter JM, Dawson LA, Kazanjian S, McGinn CJ, Brock KK, Lawrence TS, Haken RK (2001) Determination of ventilatory liver movement via radiographic evaluation of diaphragm position. Int J Radiat Oncol Biol Phys 51(1):267–270. doi: 10.1016/S0360-3016(01)01649-2

    Google Scholar 

  • Borgelt B, Gelber R, Larson M, Hendrickson F, Griffin T, Roth R (1981) Ultra-rapid high dose irradiation schedules for the palliation of brain metastases: final results of the first two studies by the radiation therapy oncology group. Int J Radiat Oncol Biol Phys 7(12):1633–1638. doi: 10.1016/0360-3016(81)90184-X

  • Case RB, Moseley DJ, Sonke JJ, Eccles CL, Dinniwell RE, Kim J, Bezjak A, Milosevic M, Brock KK, Dawson LA (2010) Interfraction and intrafraction changes in amplitude of breathing motion in stereotactic liver radiotherapy. Int J Radiat Oncol Biol Phys 77(3):918–925. S0360-3016(09)03201-5[pii], doi: 10.1016/j.ijrobp.2009.09.008

    Google Scholar 

  • Chang DT, Swaminath A, Kozak M, Weintraub J, Koong AC, Kim J, Dinniwell R, Brierley J, Kavanagh BD, Dawson LA, Schefter TE (2011) Stereotactic body radiotherapy for colorectal liver metastases: a pooled analysis. Cancer 117(17):4060–4069. doi: 10.1002/cncr.25997

    Article  PubMed  Google Scholar 

  • Dawson LA, Brock KK, Kazanjian S, Fitch D, McGinn CJ, Lawrence TS, Haken RK, Balter JM (2001) The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. 51(5):1410–1421. doi: 10.1016/S0360-3016(01)02653-0

  • Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK (2002) Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 53(4):810–821. doi: 10.1016/S0360-3016(02)02846-8

  • Dunlap NE, Cai J, Beidermann GB, Yang W, Benedict SH, Sheng K, Schefter TE, Kavanagh BD, Larner JM (2010) Chest wall volume receiving >30 gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76(3):796–801. doi: 10.1016/j.ijrobp.2009.02.027

    Google Scholar 

  • Eccles CL, Dawson LA, Moseley JL, Brock KK (2011) Interfraction liver shape variability and impact on GTV position during liver stereotactic radiotherapy using abdominal compression. Int J Radiat Oncol Biol Phys 80(3):938–946.S0360-3016(10)03049-X[pii] doi: 10.1016/j.ijrobp.2010.08.003

    Google Scholar 

  • Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122

    Google Scholar 

  • Goodman KA, Wiegner EA, Maturen KE, Zhang Z, Mo Q, Yang G, Gibbs IC, Fisher GA, Koong AC (2010) Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies. Int J Radiat Oncol Biol Phys 78(2):486–493. doi: 10.1016/j.ijrobp.2009.08.020

    Google Scholar 

  • Hawkins MA, Brock KK, Eccles C, Moseley D, Jaffray D, Dawson LA (2006) Assessment of residual error in liver position using kV cone-beam computed tomography for liver cancer high-precision radiation therapy. Int J Radiat Oncol Biol Phys 66(2):610–619. S0360-3016(06)00463-9[pii] doi: 10.1016/j.ijrobp.2006.03.026

    Google Scholar 

  • Heinzerling JH, Papiez L, Chien S, Anderson J, Forster K, Zhang G, Timmerman R (2008) Stereotactic body radiation therapy: evaluation of setup accuracy and targeting methods for a new couch integrated immobilization system. Technol Cancer Res Treat 7(3):197–206

    PubMed  Google Scholar 

  • Hellman S, Weichselbaum RR (1995) Oligometastases. J Clin Oncol 13(1):8–10

    PubMed  CAS  Google Scholar 

  • Hennessey H, Valenti D, Cabrera T (2009) Cardiac embolization of an implanted fiducial marker for hepatic stereotactic body radiotherapy: a case report. J Med Case Reports 3:140

    Article  Google Scholar 

  • Herfarth KK, Hof H, Bahner ML, Lohr F, Hoss A, van Kaick G, Wannenmacher M, Debus J (2003) Assessment of focal liver reaction by multiphasic CT after stereotactic single-dose radiotherapy of liver tumors. Int J Radiat Oncol Biol Phys 57(2):444–451. doi: 10.1016/S0360-3016(03)00586-8

    Google Scholar 

  • Hoppe BS, Laser B, Kowalski AV, Fontenla SC, Pena-Greenberg E, Yorke ED, Lovelock DM, Hunt MA, Rosenzweig KE (2008) Acute skin toxicity following stereotactic body radiation therapy for stage i non-small-cell lung cancer: who’s at risk? Int J Radiat Oncol Biol Phys 72(5):1283–1286. doi: 10.1016/j.ijrobp.2008.08.036

  • Hoyer M, Roed H, Traberg Hansen A, Ohlhuis L, Petersen J, Nellemann H, Berthelsen AK, Grau C, Aage Engelholm S, Von der maase H (2006) Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 45(7):823–830. doi: 10.1080/02841860600904854

    Article  PubMed  Google Scholar 

  • Ingold JA, Reed GB, Kaplan HS, Bagshaw MA (1965) Radiation hepatitis. Am J Roentgenol Radium Ther Nucl Med 93:200–208

    PubMed  CAS  Google Scholar 

  • Kavanagh BD, Pan CD, Dawson LA, Das SK, Li XA, Haken RKT, Miften M (2010) Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys 76(3):S101–S107. doi: 10.1016/j.ijrobp.2009.05.071

    Google Scholar 

  • Kemeny N (2006) Management of liver metastases from colorectal cancer. Oncology (Williston Park) 20(10):1161–176, 1179; discussion 1179–1180, 1185–1166

    Google Scholar 

  • Kim DJ, Murray BR, Halperin R, Roa WH (2001) Held-breath self-gating technique for radiotherapy of non-small-cell lung cancer: a feasibility study. Int J Radiat Oncol Biol Phys 49(1):43–49. S0360-3016(00)01372-9[pii]

    Google Scholar 

  • Kothary N, Heit JJ, Louie JD (2009) Safety and efficacy of percutaneous fiducial marker implantation for image-guided radiation therapy. J Vasc Interv Radiol 20(2):235–239

    Article  PubMed  Google Scholar 

  • Lanciano R, Lamond J, Yang J, Feng J, Arrigo S, Good M, Brady L (2011) Stereotactic body radiation therapy for patients with heavily pretreated liver metastases and liver tumors. Int J Radiat Oncol Bio Phys 81(2):S354

    Google Scholar 

  • Lee MT, Kim JJ, Dinniwell R, Brierley J, Lockwood G, Wong R, Cummings B, Ringash J, Tse RV, Knox JJ, Dawson LA (2009) Phase I study of individualized stereotactic body radiotherapy of liver metastases. Am Soc Clin Oncol 27(10):1585–1591. doi: 10.1200/JCO.2008.20.0600

    Article  Google Scholar 

  • Mendez Romero A, Wunderink W, van Os RM, Nowak PJ, Heijmen BJ, Nuyttens JJ, Bradwijk RP, Verhoef C, Ijzermans JNM, Levendag PC (2008) Quality of life after stereotactic body radiation therapy for primary and metastatic liver tumors. Int J Radiat Oncol Biol Phys 70(5):1447–1452. doi: 10.1016/j.ijrobp.2007.08.058

    Google Scholar 

  • Mendez Romero A, Zinkstok RT, Wunderink W, van Os RM, Joosten H, Seppenwoolde Y, Nowak PJ, Brandwijk RP, Verhoef C, JN IJ, Levendag PC, Heijmen BJ (2009) Stereotactic body radiation therapy for liver tumors: impact of daily setup corrections and day-to-day anatomic variations on dose in target and organs at risk. Int J Radiat Oncol Biol Phys 75(4):1201–1208. S0360-3016(08)03916-3[pii]

    Article  PubMed  Google Scholar 

  • Nambu A, Onishi H, Aoki S, Koshiishi T, Kuriyama K, Komiyama T, Marino K, Araya M, Saito R, Tominaga L, Maehata Y, Sawada E, Araki T (2011) Rib reacture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients. Radiat Oncol 13(6):137

    Article  Google Scholar 

  • Olsen CC, Welsh J, Kavanagh BD, Franklin W, McCarter M, Cardenes HR, Gaspar LE, Schefter TE (2009) Microscopic and macroscopic tumor and parenchymal effect of liver stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 73(5):1414–1424. doi: 10.1016/j.ijrobp.2008.12.020

    Google Scholar 

  • Pan CC, Kavanagh BD, Dawson LA, Li XA, Das SK, Miften M, Haken RKT (2010) Radiation-associated liver injury. Int J Radiat Oncol Biol Phys 76(3):S94–S100. doi: 10.1016/j.ijrobp.2009.06.092

    Google Scholar 

  • Patel S, McCall M, Ohinmaa A, Bigam D, Dryden DM (2011) Positron emission tomography/computed tomographic scans compared to computed tomographic scans for detecting colorectal liver metastases: a systematic review. Ann Surg 253(4):666–671. doi: 10.1097/SLA.0b013e31821110c9

    Article  PubMed  Google Scholar 

  • Pettersson N, Nyman J, Johansson KA (2009) Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose-and volume-response analysis. Radiother Oncol. Jun;91(3):360–368. Epub 2009, May 4.00000658-201104000-00006[pii]

    Google Scholar 

  • Reed GB, Cox AJ (1966) The human liver after radiation injury. A form of veno-occlusive disease. Am J Pathol 48(4):597–611

    PubMed  Google Scholar 

  • Robertson DJ, Stukel TA, Gottlieb DJ, Sutherland JM, Fisher ES (2009) Survival after hepatic resection of colorectal cancer metastases: a national experience. Cancer 115(4):752–759. doi: 10.1002/cncr.24081

    Article  PubMed  Google Scholar 

  • Rule W, Timmerman R, Tong L (2011) Phase I dose-escalation study of stereotactic body radiotherapy in patients with hepatic metastases. Ann Surg Oncol. 18:1081–1087

    Google Scholar 

  • Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, Chidel MA, Pugh TJ, Franklin W, Kane M, Gaspar LE, Schefter TE (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 27(10):1572–1578. JCO.2008.19.6329[pii] doi: 10.1200/JCO.2008.19.6329

    Google Scholar 

  • Schefter TE, Kavanagh BD, Timmerman RD, Cardenes HR, Baron A, Gaspar LE (2005) A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys 62(5):1371–1378. doi: 10.1016/j.ijrobp.2005.01.002

    Google Scholar 

  • Shirato H, Shimizu S, Kitamura K, Nishioka T, Kagei K, Hashimoto S, Aoyama H, Kunieda T, Shinohara N, Dosaka-Akita H, Miyasaka K (2000) Four-dimensional treatment planning and fluoroscopic real-time tumor tracking radiotherapy for moving tumor. Int J Radiat Oncol Biol Phys 48(2):435–442. S0360-3016(00)00625-8[pii]

    Article  PubMed  CAS  Google Scholar 

  • Stintzing S, Hoffmann RT, Heinemann V, Kufeld M, Rentsch M, Muacevic A (2010) Radiosurgery of liver tumors: value of robotic radiosurgical device to treat liver tumors. Ann Surg Oncol Nov 17(11):2877–2883. Epub 2010Jun 24

    Google Scholar 

  • Vautravers-Dewas C, Dewas S, Bonodeau F, Adenis A, Lacornerie T, Penel N, Lartigau E, Mirabel X (2011) Image-guided robotic stereotactic body radiation therapy for liver metastases: is there a dose response relationship? Int J Radiat Oncol Biol Phys. S0360-3016(11)00042-3[pii]

    PubMed  Google Scholar 

  • van der Pool AE, Mendez Romero A, Wunderink W, Heijmen BJ, Levendag PC, Verhoef C, Ijzermans JNM (2010) Stereotactic body radiation therapy for colorectal liver metastases. British J Surg 97(3):377–382. doi: 10.1002/bjs.689510.1016/j.ijrobp.2010.12.047

    Article  Google Scholar 

  • Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 50(Suppl 1):122S–150S. 50/Suppl_1/122S[pii]

    Google Scholar 

  • Wang Z, Nelson JW, Yoo S, Wu QJ, Kirkpatrick JP, Marks LB, Yin FF (2009) Refinement of treatment setup and target localization accuracy using three-dimensional cone-beam computed tomography for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 73(2):571–577. S0360-3016(08)03530-X[pii] 10.1016/j.ijrobp.2008.09.040

    Google Scholar 

  • Worm ES, Hansen AT, Petersen JB, Muren LP, Praestegaard LH, Hoyer M (2010) Inter- and intrafractional localisation errors in cone-beam CT guided sterotactic radiation therapy of tumors in the liver and lung. Acta Oncol 49(7):1177–1183. doi: 10.3109/0284186X.2010.498435

    Article  PubMed  Google Scholar 

  • Wulf J, Guckenberger M, Haedinger U, Oppitz U, Mueller G, Baier K, Flentje M (2006) Stereotactic radiotherapy of primary liver cancer and hepatic metastases. Acta Oncol 45(7):838–847. NU5W708282324644[pii] doi: 10.1080/02841860600904821

    Google Scholar 

  • Yin FF, Zhiheng W, Yoo S, Wu QJ, Kirkpatrick J, Larrier N, Meyer J, Willeyy CG, Marks LB (2008) Integration of cone-beam CT in stereotactic body radiation therapy. Technol Cancer Res Treat 7(2):133–139

    PubMed  Google Scholar 

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Conflict of Interest

There are no potential conflicts of interest among the authors and this manuscript. There are no financial or non-financial competing interests. This manuscript has been seen, read, and agreed upon in its content by all designated authors. This manuscript has not been submitted or published elsewhere.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, 80045, USA

    Michelle Stinauer, Tracey E. Schefter, Brian Kavanagh & Julie A. Carlson

  2. Department of Radiation Oncology, Delaware County Memorial Hospital, Philadelphia CyberKnife, Drexel Hill, PA, 19026, USA

    Rachelle Lanciano

  3. Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 647, Rochester, NY, 14642, USA

    Alan W. Katz

Authors
  1. Michelle Stinauer
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  2. Rachelle Lanciano
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  3. Tracey E. Schefter
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  4. Brian Kavanagh
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  5. Julie A. Carlson
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  6. Alan W. Katz
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Corresponding author

Correspondence to Alan W. Katz .

Editor information

Editors and Affiliations

  1. , Department of Radiation Oncology, Case Western Reserve University, Euclid Avenue 11100, Cleveland, 44106, Ohio, USA

    Simon S. Lo

  2. , Department of Radiation Oncology, Weil Cornell Medical College, Fannin, Ste#DB1-077 6565, Houston, 77030, Texas, USA

    Bin S. Teh

  3. Cancer Institute, Department of Radiation Oncology, National University Hospital, Lower Kent Ridge Road 5, Singapore, 119074, Singapore

    Jiade J. Lu

  4. , Department of Radiation Oncology, University of Colorado, Aurora, 80045, Colorado, USA

    Tracey E. Schefter

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© 2012 Springer-Verlag Berlin Heidelberg

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Stinauer, M., Lanciano, R., Schefter, T.E., Kavanagh, B., Carlson, J.A., Katz, A.W. (2012). Liver Metastasis. In: Lo, S., Teh, B., Lu, J., Schefter, T. (eds) Stereotactic Body Radiation Therapy. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_503

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  • DOI: https://doi.org/10.1007/174_2011_503

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-25604-2

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