BACKGROUND: There is growing interest in stereotactic body radiation therapy (SBRT) as a noninvasive means of treating inoperable hepatic metastases and primary intrahepatic hepatobiliary carcinomas. While initial outcomes are encouraging, the safety of delivering such large, ablative doses is still being studied. METHODS: We compiled all dose-volume constraints from seven prospective trials of liver SBRT and linked them to reported toxicities. Dose thresholds were made isoeffective, and grade 3 or higher toxicities for liver and adjacent normal tissues were correlated. RESULTS: Four cases of grade 3-5 radiation-induced liver disease (RILD) were identified, including 1 treatment related death, from all patients treated for metastasis. Three of these 4 cases were linked to excessive radiation doses in a large volume of liver. In 56 patients treated for hepatocellular carcinoma (HCC), 1 case of grade 5 RILD and 2 cases of grade 2 hepatic toxicity were reported. Additionally, a prominent retrospective series reported 3 cases of grade 5 RILD in 9 patients treated for HCC. CONCLUSIONS: SBRT appears to be safe for treatment of hepatic metastasis. The use of SBRT for HCC should be undertaken with caution or within the context of a clinical trial. Strict adherence to reported dose-volume constraints is advocated.
BACKGROUND: There is growing interest in stereotactic body radiation therapy (SBRT) as a noninvasive means of treating inoperable hepatic metastases and primary intrahepatic hepatobiliary carcinomas. While initial outcomes are encouraging, the safety of delivering such large, ablative doses is still being studied. METHODS: We compiled all dose-volume constraints from seven prospective trials of liver SBRT and linked them to reported toxicities. Dose thresholds were made isoeffective, and grade 3 or higher toxicities for liver and adjacent normal tissues were correlated. RESULTS: Four cases of grade 3-5 radiation-induced liver disease (RILD) were identified, including 1 treatment related death, from all patients treated for metastasis. Three of these 4 cases were linked to excessive radiation doses in a large volume of liver. In 56 patients treated for hepatocellular carcinoma (HCC), 1 case of grade 5 RILD and 2 cases of grade 2 hepatic toxicity were reported. Additionally, a prominent retrospective series reported 3 cases of grade 5 RILD in 9 patients treated for HCC. CONCLUSIONS: SBRT appears to be safe for treatment of hepatic metastasis. The use of SBRT for HCC should be undertaken with caution or within the context of a clinical trial. Strict adherence to reported dose-volume constraints is advocated.
Authors: Mishal Mendiratta-Lala; William Masch; Prasad R Shankar; Holly E Hartman; Matthew S Davenport; Matthew J Schipper; Chris Maurino; Kyle C Cuneo; Theodore S Lawrence; Dawn Owen Journal: Int J Radiat Oncol Biol Phys Date: 2018-09-10 Impact factor: 7.038
Authors: Zhao-Chong Zeng; Jinsil Seong; Sang Min Yoon; Jason Chia-Hsien Cheng; Ka-On Lam; Ann-Shing Lee; Ada Law; Jian-Ying Zhang; Yong Hu Journal: Liver Cancer Date: 2017-08-30 Impact factor: 11.740
Authors: Timothy D Solberg; James M Balter; Stanley H Benedict; Benedick A Fraass; Brian Kavanagh; Curtis Miyamoto; Todd Pawlicki; Louis Potters; Yoshiya Yamada Journal: Pract Radiat Oncol Date: 2011-09-15