Eleni Gkika1,2, Iosif Strouthos3, Simon Kirste3, Sonja Adebahr3, Michael Schultheiss4, Dominik Bettinger4,5, Ralph Fritsch6, Volker Brass4, Lars Maruschke7, Hannes Philipp Neeff8, Sven Arke Lang8, Ursula Nestle3,9,10,11, Anca-Ligia Grosu3,9,10,12, Thomas Baptist Brunner3,9,10,12. 1. Departmentof Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany. eleni.gkika@uniklinik-freiburg.de. 2. University Medical Center Freiburg, Freiburg, Germany. eleni.gkika@uniklinik-freiburg.de. 3. Departmentof Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany. 4. Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Medical Center Freiburg, Freiburg, Germany. 5. Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 6. Department of Internal Medicine, Hematology, Oncology and Stem-Cell Transplantation, University Medical Center Freiburg, Freiburg, Germany. 7. Department of Radiology, University Medical Center Freiburg, Freiburg, Germany. 8. Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany. 9. Partner Site Freiburg, German Cancer Consortium (DKTK), Freiburg, Germany. 10. Faculty of Medicine, University of Freiburg, Freiburg, Germany. 11. Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany. 12. German cancer Research Center (DKFZ), Heidelberg, Germany.
Abstract
PURPOSE: To evaluate the feasibility and toxicity profile of repeated stereotactic body radiotherapy (SBRT) for recurrent primary or secondary liver tumors. METHODS: Consecutive patients with primary (hepatocellular carcinoma [HCC] or cholangiocarcinoma [CCC]) or secondary liver cancer (LM), with intrahepatic recurrence or progression after SBRT, underwent re-SBRT in 3 to 12 fractions with a median time of 15 (range 2-66) months between treatments. RESULTS: In all, 24 patients which were previously treated with SBRT (30 lesions) were retreated with SBRT for "in- and out-of-field" recurrences (2nd SBRT: n = 28, 3rd SBRT: n = 2). The median follow-up after re-irradiation was 14 months. The median prescribed dose for the first SBRT was 46.5 (range 33-66 Gy, EQD210 = 70.5) Gy and 48 (range 27-66 Gy, EQD210 = 71) Gy for the re-SBRT. The median mean liver dose (Dmean, liver) was 6 Gy (range 1-25, EQD22 = 7 Gy) for the first SBRT and 10 Gy (range 1-63 Gy, EQD22 = 9 Gy) for the re-SBRT. Of the 30 re-irradiated lesions 6 were re-irradiated in-field resulting in a median EQD22, maximum of 359 (range 120-500) Gy for both treatments, with an α/β = 2 to account for liver parenchyma. Treatment was well tolerated. Two patients with stent placement before SBRT developed cholangitis 4 and 14 months after re-SBRT. There were no elevations of the serum liver parameters after re-SBRT. One patient developed a grade 3 gastrointestinal bleeding. There was no radiation induced liver disease (RILD) observed. CONCLUSIONS: Repeated liver SBRT is feasible, without excessive liver toxicity, when there is no considerable overlapping with pre-irradiated portions of the stomach or bowel and enough time for the liver to regenerate.
PURPOSE: To evaluate the feasibility and toxicity profile of repeated stereotactic body radiotherapy (SBRT) for recurrent primary or secondary liver tumors. METHODS: Consecutive patients with primary (hepatocellular carcinoma [HCC] or cholangiocarcinoma [CCC]) or secondary liver cancer (LM), with intrahepatic recurrence or progression after SBRT, underwent re-SBRT in 3 to 12 fractions with a median time of 15 (range 2-66) months between treatments. RESULTS: In all, 24 patients which were previously treated with SBRT (30 lesions) were retreated with SBRT for "in- and out-of-field" recurrences (2nd SBRT: n = 28, 3rd SBRT: n = 2). The median follow-up after re-irradiation was 14 months. The median prescribed dose for the first SBRT was 46.5 (range 33-66 Gy, EQD210 = 70.5) Gy and 48 (range 27-66 Gy, EQD210 = 71) Gy for the re-SBRT. The median mean liver dose (Dmean, liver) was 6 Gy (range 1-25, EQD22 = 7 Gy) for the first SBRT and 10 Gy (range 1-63 Gy, EQD22 = 9 Gy) for the re-SBRT. Of the 30 re-irradiated lesions 6 were re-irradiated in-field resulting in a median EQD22, maximum of 359 (range 120-500) Gy for both treatments, with an α/β = 2 to account for liver parenchyma. Treatment was well tolerated. Two patients with stent placement before SBRT developed cholangitis 4 and 14 months after re-SBRT. There were no elevations of the serum liver parameters after re-SBRT. One patient developed a grade 3 gastrointestinal bleeding. There was no radiation induced liver disease (RILD) observed. CONCLUSIONS: Repeated liver SBRT is feasible, without excessive liver toxicity, when there is no considerable overlapping with pre-irradiated portions of the stomach or bowel and enough time for the liver to regenerate.
Entities:
Keywords:
Cholangiocarcinoma; Hepatocellular carcinoma; Liver metastases; Re-SBRT; Stereotactic body radiotherapy
Authors: Charlie C Pan; Brian D Kavanagh; Laura A Dawson; X Allen Li; Shiva K Das; Moyed Miften; Randall K Ten Haken Journal: Int J Radiat Oncol Biol Phys Date: 2010-03-01 Impact factor: 7.038
Authors: Alexis Bujold; Christine A Massey; John J Kim; James Brierley; Charles Cho; Rebecca K S Wong; Rob E Dinniwell; Zahra Kassam; Jolie Ringash; Bernard Cummings; Jenna Sykes; Morris Sherman; Jennifer J Knox; Laura A Dawson Journal: J Clin Oncol Date: 2013-04-01 Impact factor: 44.544
Authors: K K Herfarth; J Debus; F Lohr; M L Bahner; B Rhein; P Fritz; A Höss; W Schlegel; M F Wannenmacher Journal: J Clin Oncol Date: 2001-01-01 Impact factor: 44.544
Authors: Shaelyn Culleton; Haiyan Jiang; Carol R Haddad; John Kim; Jim Brierley; Anthony Brade; Jolie Ringash; Laura A Dawson Journal: Radiother Oncol Date: 2014-06-03 Impact factor: 6.280
Authors: Alejandra Méndez Romero; Wouter Wunderink; Rob M van Os; Peter J C M Nowak; Ben J M Heijmen; Joost J Nuyttens; Rene P Brandwijk; Cornelis Verhoef; Jan N M Ijzermans; Peter C Levendag Journal: Int J Radiat Oncol Biol Phys Date: 2007-11-08 Impact factor: 7.038
Authors: E A Eisenhauer; P Therasse; J Bogaerts; L H Schwartz; D Sargent; R Ford; J Dancey; S Arbuck; S Gwyther; M Mooney; L Rubinstein; L Shankar; L Dodd; R Kaplan; D Lacombe; J Verweij Journal: Eur J Cancer Date: 2009-01 Impact factor: 9.162
Authors: Laura A Dawson; Daniel Normolle; James M Balter; Cornelius J McGinn; Theodore S Lawrence; Randall K Ten Haken Journal: Int J Radiat Oncol Biol Phys Date: 2002-07-15 Impact factor: 7.038