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Stereotactic radiotherapy in the liver hilum

Basis for future studies

Stereotaktische Strahlentherapie in der Leberpforte

Grundlagen für zukünftige Studien

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Abstract

Background

A basis for future trials with stereotactic body radiotherapy (SBRT) for tumors of the liver hilum should be established. Thus, dosage concepts, planning processes, and dose constraints as well as technical innovations are summarized in this contribution.

Methods

On the background of our own data, the current literature was reviewed. The use of SBRT in the most common tumors of the liver hilum (pancreatic cancer and Klatskin tumors) was investigated. Dose constraints were calculated in 2 Gy standard fractionation doses.

Results

A total of 8 pilot or phase I/II studies about SBRT in the liver hilum were identified. In recent years, the SBRT technique has developed very quickly from classical stereotactic body frame radiotherapy to IGRT techniques including gating and tracking systems. In the studies using classical body frame technique, patients experienced considerable toxicities (duodenal ulcer/perforation) as compared to tolerable side effects in IGRT studies (<10% grade 3 and 4 toxicities). Dose constraints for duodenum, liver, kidneys, colon, and spinal cord were derived from the investigated studies. Survival and local tumor control data are very heterogeneous: median survival in these patients with locally advanced pancreatic or Klatskin tumors ranges between 5 and 32 months. Excellent local tumor control rates of about 80% over 24 months were achieved using SBRT.

Conclusion

Despite a few negative results, SBRT seems to be a promising technique in the treatment of tumors of the liver hilum. Highest precision in diagnostics, positioning, and irradiation as well as strict dose constraints should be applied to keep target volumes as small as possible and side effects tolerable.

Zussammenfasung

Hintergrund

Es sollte eine Basis für zukünftige Studien mit Körperstammstereotaxie (SBRT) im Bereich der Leberpforte gelegt werden. Hierfür wurden Dosierungskonzepte, Planungsprozesse und Grenzdosen sowie technische Innovationen betrachtet.

Methoden

Vor dem Hintergrund eigener Daten wurde die aktuelle Literatur zusammengefasst. Die SBRT wurde bei den gängigsten Tumoren der Leberpforte (Pankreaskarzinom und Klatskin-Tumor) untersucht. Grenzdosen wurden für eine 2-Gy-Standardfraktionierung errechnet.

Ergebnisse

Insgesamt wurden 8 Pilot- oder Phase-I/II-Studien über SBRT in der Leberpforte gefunden. In den letzten Jahren hat sich die SBRT sehr schnell von der klassischen Körperstammstrahlentherapie im stereotaktischen Rahmen zur bildgeführten Strahlentherapie (IGRT), einschließlich der Gating- und Tracking-Systeme, weiterentwickelt. Die Patienten in den Studien mit der klassischen Technik erfuhren erhebliche (Ulcera/Perforationen des Duodenums), die in den IGRT-Studien tolerable Nebenwirkungen (Toxizitätsrate Grad 3 und 4 < 10%). Grenzdosen für Duodenum, Leber, Nieren, Kolon und Rückenmark konnten den untersuchten Studien entnommen werden. Die Daten für das Überleben und die lokale Tumorkontrolle sind sehr heterogen: Das mediane Überleben dieser Patienten mit weit fortgeschrittenen Pankreaskarzinomen oder Klatskin-Tumoren betrug zwischen 5 und 32 Monaten. Exzellente Raten für die lokale Tumorkontrolle von etwa 80% über 24 Monate waren mit der SBRT erreichbar.

Zusammenfassung

Trotz einiger negativer Ergebnisse scheint die SBRT eine vielversprechende Technik bei der Behandlung von Tumoren der Leberpforte zu sein. Höchste Präzision bei Diagnostik, Positionierung und Bestrahlung sowie strenge Grenzdosen müssen eingehalten werden, um Zielvolumina möglichst klein und die Nebenwirkungen tolerabel zu halten.

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany

    C. Zamboglou, M.-B. Meßmer &  F. Momm

  2. Department of Gastroenterology and Hepatology, University Hospital Freiburg, Freiburg, Germany

    G. Becker

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  1. C. Zamboglou
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  2. M.-B. Meßmer
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  3. G. Becker
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  4. F. Momm
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Correspondence to F. Momm.

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Zamboglou, C., Meßmer, MB., Becker, G. et al. Stereotactic radiotherapy in the liver hilum. Strahlenther Onkol 188, 35–41 (2012). https://doi.org/10.1007/s00066-011-0002-2

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