Radiosurgery for recurring liver metastases after hepatectomy.

BACKGROUND/AIMS: Most resected liver metastases from colorectal cancer recur. A minority of liver recurrences have been re-resected, but most re-resections fail and they decrease the postoperative performance status for a longer time than the initial resections, so that less demanding potentially curative treatments need evaluation.
METHODOLOGY: Four out of 5 liver-only recurrences after 18 consecutive liver resections were limited and suitable for radiosurgery. The patients were fixed in a frame and stereotactic irradiation with 20 Gy twice or 15 Gy three times was delivered to the tumors.
RESULTS: Limited side effects were seen, without medical need for hospital admission. Thirteen--101 months later, all treated tumors were locally controlled with complete radiologic remission of two of them. Only one patient recurred in the liver, with bilobar lesions preceded by extrahepatic spread. Neither recurrence would have been prevented by a rehepatectomy instead of irradiation. One patient died later tumor-free from stroke, two died from generalized tumors, and one remains in remission 101 months after radiosurgery.
CONCLUSIONS: Radiosurgery of liver tumors merits further study, and may offer a less demanding alternative to resection for selected liver tumors with the prospect of long-term survival.