Hypofractionated image-guided breath-hold SABR (stereotactic ablative body radiotherapy) of liver metastases--clinical results

Autor: Martine Ottstadt, Frank Lohr, Judit Boda-Heggemann, Kerstin Siebenlist, Ralf-Dieter Hofheinz, Frederik Wenz, Frank Schneider, Ulrike I. Attenberger, Christel Weiss, Anian Frauenfeld, Dietmar Dinter
Rok vydání: 2012
Předmět:
lcsh:Medical physics. Medical radiology. Nuclear medicine
Adult
Male
Survival
medicine.medical_treatment
lcsh:R895-920
Hypofractionated image-guided breath-hold SABR
SABR volatility model
Radiosurgery
Effective dose (radiation)
lcsh:RC254-282
Breath Holding
Cohort Studies
Liver metastases
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Survival analysis
Aged
Retrospective Studies
Aged
80 and over
Toxicity
business.industry
Radiotherapy Planning
Computer-Assisted
Research
Carcinoma
Liver Neoplasms
Dose fractionation
Retrospective cohort study
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Survival Analysis
Radiation therapy
Treatment Outcome
Oncology
Radiology Nuclear Medicine and imaging
Local control
Female
Dose Fractionation
Radiation
Nuclear medicine
business
Cohort study
Radiotherapy
Image-Guided
Zdroj: Radiation Oncology (London, England)
Radiation Oncology, Vol 7, Iss 1, p 92 (2012)
ISSN: 1748-717X
Popis: Purpose Stereotactic Ablative Body Radiotherapy (SABR) is a non-invasive therapy option for inoperable liver oligometastases. Outcome and toxicity were retrospectively evaluated in a single-institution patient cohort who had undergone ultrasound-guided breath-hold SABR. Patients and methods 19 patients with liver metastases of various primary tumors consecutively treated with SABR (image-guidance with stereotactic ultrasound in combination with computer-controlled breath-hold) were analysed regarding overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC), acute and late toxicity. Results PTV (planning target volume)-size was 108 ± 109cm3 (median 67.4 cm3). BED2 (Biologically effective dose in 2 Gy fraction) was 83.3 ± 26.2 Gy (median 78 Gy). Median follow-up and median OS were 12 months. Actuarial 2-year-OS-rate was 31%. Median PFS was 4 months, actuarial 1-year-PFS-rate was 20%. Site of first progression was predominantly distant. Regression of irradiated lesions was observed in 84% (median time to detection of regression was 2 months). Actuarial 6-month-LC-rate was 92%, 1- and 2-years-LC-rate 57%, respectively. BED2 influenced LC. When a cut-off of BED2 = 78 Gy was used, the higher BED2 values resulted in improved local control with a statistical trend to significance (p = 0.0999). Larger PTV-sizes, inversely correlated with applied dose, resulted in lower local control, also with a trend to significance (p-value = 0.08) when a volume cut-off of 67 cm3 was used. No local relapse was observed at PTV-sizes 3 and BED2 > 78 Gy. No acute clinical toxicity > °2 was observed. Late toxicity was also ≤ °2 with the exception of one gastrointestinal bleeding-episode 1 year post-SABR. A statistically significant elevation in the acute phase was observed for alkaline-phosphatase; in the chronic phase for alkaline-phosphatase, bilirubine, cholinesterase and C-reactive protein. Conclusions A trend to statistically significant correlation of local progression was observed for BED2 and PTV-size. Dose-levels BED2 > 78 Gy cannot be reached in large lesions constituting a significant fraction of this series. Image-guided SABR (igSABR) is therefore an effective non-invasive treatment modality with low toxicity in patients with small inoperable liver metastases.
Databáze: OpenAIRE
Externí odkaz: