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Colorectal Cancer Liver Metastases pp 547–560Cite as

External Radiation for Unresectable CRLM

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Abstract

Surgical resection is the standard of treatment for selected secondary liver tumors, but less than 20% of patients are amenable to an operation due to advanced local disease or a medical condition. Alternative local/regional therapies have commonly been used for palliation or in attempt to cure. Radiofrequency ablation (RFA), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), and Y90 embolization have encountered limitations mainly as a result of the tumor location, size, number, or hepatic injury following chemotherapy. Modern radiation techniques have modified the role of radiation therapy in this clinical situation and have led to an establishment of this treatment modality in liver cancer patients. Thus, application of even high tumoricidal doses can be applied safely and noninvasively by stereotactic body radiotherapy (SBRT), intensity-modulated radiotherapy (IMRT), or even particle beam therapy (PBT). The size and number of lesions that can be targeted and dose or radiation that can be delivered are dependent primarily on normal liver reserve and estimated risk of liver complications. Typically, treatment is delivered in three to six fractions with minimum 1–3 days between each fraction. The dose prescribed depends on baseline liver function and normal tissue constraints. In general, the highest allowable dose to the tumor(s) that respects normal tissue constraints is selected. With the more generally adopted dosing regimens, overall local control rates for small liver tumors (6 cm or less) range from 70% to 90% at 2 years. It has also been shown that higher doses are associated with improved local control. Toxicity rates are very low, although associated with poor baseline liver dysfunction, stressing the importance of careful patient and dose selection.

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Authors and Affiliations

  1. Radiation Oncologist, Instituto Nacional de Câncer, Rio de Janeiro, Brazil

    Raquel Guimarães Domingos da Silva

  2. Radiation Oncologist, HM Hospitales, Madrid, Spain

    M. Carmen Rubio Rodriguez

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  1. Raquel Guimarães Domingos da Silva
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Editors and Affiliations

  1. National Cancer Institute, Rio de Janeiro, Brazil

    Mauro Monteiro Correia

  2. Banner MD Anderson Cancer Center, Phoenix, AZ, USA

    Michael A. Choti

  3. Virginia Mason Medical Center, Seattle, WA, USA

    Flavio G. Rocha

  4. Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo Shi, Saitama, Japan

    Go Wakabayashi

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da Silva, R.G.D., Rodriguez, M.C.R. (2020). External Radiation for Unresectable CRLM. In: Correia, M., Choti, M., Rocha, F., Wakabayashi, G. (eds) Colorectal Cancer Liver Metastases. Springer, Cham. https://doi.org/10.1007/978-3-030-25486-5_40

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