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Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques

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Abstract

Purpose

Stereotactic body radiotherapy (SBRT) has been firmly established as a treatment choice for patients with oligometastases, as it has demonstrated both safety and efficacy by consistently achieving high rates of local control. Moreover, it offers potential survival benefits for carefully selected patients in real-world clinical settings.

Methods

Between January 2008 and May 2020, a total of 149 patients (with 414 liver metastases) received treatment. The Active Breathing Coordinator device was used for 68 patients, while respiratory gating was used for 65 and abdominal compression was used for 16 patients. The most common histological finding was colorectal adenocarcinoma, with 37.6% of patients having three or more metastases, and 18% having two metastases. The prescribed dose ranged from 36 to 60 Gy, delivered in 3–5 fractions.

Results

Local control rates at 2 and 3 years were 76.1% and 61.2%, respectively, with no instances of local recurrence after 3 years. Factors negatively impacting local control included colorectal histology, lower prescribed dose, and the occurrence of new liver metastases. The median overall survival from SBRT was 32 months, with the presence of metastases outside the liver and the development of new liver metastases after SBRT affecting survival. The median disease-free survival was 10 months. No substantial differences in both local control and survival were observed between the respiratory motion control techniques employed. Treatment tolerance was excellent, with only one patient experiencing acute grade IV thrombocytopenia and two patients suffering from ≥ grade II chronic toxicity.

Conclusion

For radical management of single or multiple liver metastases, SBRT is an effective and well-tolerated treatment option. Regardless of the technology employed, experienced physicians can achieve similarly positive outcomes. However, additional studies are required to elucidate prognostic factors that can facilitate improved patient selection.

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Acknowledgements

We thank Daniel García de Quinto, for reviewing, revising, and editing this manuscript for English language grammar and syntax.

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Authors and Affiliations

  1. Radiation Oncology Department, University Hospital HM Puerta del Sur, Madrid, Spain

    O. Hernando-Requejo MD PhD, X. Chen MD PhD, R. Alonso MD & C. Rubio MD PhD

  2. Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain

    O. Hernando-Requejo MD PhD, M. López MD, E. Sánchez MD, A. Montero MD PhD, R. Ciervide MD PhD, B. Álvarez MD PhD, M. García Aranda MD, J. Valero MD & C. Rubio MD PhD

  3. Radiation Physics Department, University Hospital HM Puerta del Sur, Madrid, Spain

    J. García PhD & P. García

  4. Radiation Physics Department, University Hospital HM Sanchinarro, Madrid, Spain

    D. Zucca PhD & P. Fernández Letón

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  1. O. Hernando-Requejo MD PhD
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Correspondence to O. Hernando-Requejo MD PhD.

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Conflict of interest

O. Hernando-Requejo, X. Chen, M. López, E. Sánchez, J. García, P. García, R. Alonso, A. Montero, R. Ciervide, B. Álvarez, D. Zucca, M. García Aranda, J. Valero, P. Fernández Letón and C. Rubio declare that they have no competing interests.

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All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Hernando-Requejo, O., Chen, X., López, M. et al. Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques. Strahlenther Onkol 199, 1000–1010 (2023). https://doi.org/10.1007/s00066-023-02147-w

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