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Role of stereotactic body radiation therapy in the treatment of liver metastases: clinical results and prognostic factors

Rolle von stereotaktischer Körperbestrahlungstherapie in der Behandlung von Lebermetastasen: klinische Befunde und prognostische Faktoren

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Abstract

Purpose

To evaluate feasibility and efficacy of Stereotactic Body Radiation Therapy (SBRT) for unresectable liver metastasis in oligometastatic patients.

Methods

Oligometastatic patients with up to three liver metastases of a maximum diameter of 6 cm were treated with SBRT. Total dose was 75 Gy in three consecutive fractions. Study endpoints were efficacy of this fractionation in terms of local control (LC), overall survival (OS), toxicity, and prognostic factors affecting OS and LC.

Results

Between February 2010 and December 2016, we enrolled 202 patients, with a total of 268 unresectable liver metastases. Median follow-up time from SBRT was 33 months (5–87 months). One-, 3‑, and 5‑year LC rates were 92%, 84%, and 84%, respectively. In univariate analysis, the primary histology and previous local ablative therapies were significant. Median OS was 21 months and the survival rates were 79%, 27%, and 15% at 1, 3, and 5 years after SBRT, respectively. At univariate analysis, sex, primary disease histology, intra-, and extra-hepatic progression were significant prognostic factors. This analysis confirmed the absence of late toxicity >G3.

Conclusion

This study confirms the efficacy and safety of SBRT for unresectable liver metastases. Selection of cases may improve survival and LC.

Zusammenfassung

Zielsetzung

Bewertung von Durchführbarkeit und Wirksamkeit von SBRT („stereotactic body radiation therapy“), für nichtresezierbare Lebermetastasen bei oligometastatischen Patienten.

Methoden

Oligometastatische Patienten mit bis zu 3 Lebermetastasen mit einem maximalen Durchmesser von 6 cm wurden mit SBRT behandelt. Gesamtdosis war 75 Gy in 3 Fraktionen hintereinander. Endpunkt der Untersuchung war die Wirksamkeit der Fraktionierung bezüglich lokaler Kontrolle (LC), Gesamtüberleben (OS), Toxizität und prognostischer Faktoren mit Einfluss auf OS und LC.

Ergebnisse

Zwischen Februar 2010 und Dezember 2016 wurden 202 aus 268 Patienten mit nichtresezierbaren Lebermetastasen ausgewählt. Mediane Nachbeobachtungszeit nach SBRT war 33 Monate (Spanne 5–87 Monate). Die 1‑, 3‑ und 5‑Jahres-LC-Raten lagen jeweils bei 92%, 84% und 84%. In der univariaten Analyse waren die Primärhistologie und die früheren ablativen lokalen Therapien signifikant. Das mediane OS lag bei 21 Monaten und die Überlebensraten waren 1, 3 und 5 Jahre nach SBRT jeweils bei 79%, 27% und 15%. In der univariaten Analyse waren Geschlecht, primäre Krankheitshistologie, intra- und extrahepatische Progression signifikante prognostische Faktoren. Diese Analyse bestätigte die Abwesenheit von Spättoxizität >G3.

Schlussfolgerung

Diese Untersuchung bestätigt die Wirksamkeit und die Sicherheit von SBRT für nichtresezierbare Lebermetastasen. Eine Fallauswahl kann die Überlebensrate und die LC verbessern.

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Authors and Affiliations

  1. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Milan, Italy

    Elena Clerici M.D., Tiziana Comito M.D.,  Ciro Franzese M.D., Lucia Di Brina M.D., Angelo Tozzi M.D., Cristina Iftode M.D., Pierina Navarria M.D., Pietro Mancosu M.D., Giacomo Reggiori M.D., Stefano Tomatis M.D. & Marta Scorsetti M.D.

  2. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Ciro Franzese M.D. & Marta Scorsetti M.D.

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  1. Elena Clerici M.D.
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Correspondence to Ciro Franzese M.D..

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E. Clerici, T. Comito, C. Franzese, L. Di Brina, A. Tozzi, C. Iftode, P. Navarria, P. Mancosu, G. Reggiori, S. Tomatis, and M. Scorsetti declare that they have no competing interests.

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Clerici, E., Comito, T., Franzese, C. et al. Role of stereotactic body radiation therapy in the treatment of liver metastases: clinical results and prognostic factors. Strahlenther Onkol 196, 325–333 (2020). https://doi.org/10.1007/s00066-019-01524-8

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