Abstract
PurposeTo report on outcome and toxicity of stereotactic body radiotherapy (SBRT) for liver metastases in patients not eligible for surgery.MethodsFrom 2000 to 2009, 74 patients with 91 liver metastases from different primaries have been treated with SBRT at our institution. Median planning target volume was 123 ccm (range: 10.6-1074 ccm). Treatment consisted of 3–5 fractions with 5–12.5 Gy/ fraction prescribed to the surrounding 60-95% isodose with daily image guidance. Regular follow-up included CT or MRI imaging until tumor progression.ResultsMedian local recurrence-free interval was 23 months with a local control rate of 74.7%, 48.3% and 48.3% after 1, 2 and 3 years. Only minimum biologically effective dose (BED) to gross tumor volume (GTV) remained as independent significant factor for local control in multivariate analysis. No local recurrences were observed in lesions (n = 12) which received a minimal BED to the GTV of 120 Gy. Including 26 local recurrences, 67 patients (91%) showed disease progression after SBRT with a median time of 5 months. Median overall survival was 27 months with survival rates of 77%, 30% and 27% at 1, 3 and 5 years. On multivariate analysis only GTV volume remained as independent significant prognostic factor for overall survival (p = 0.002). No grade 3 to 5 acute toxicity and no grade 4 or 5 late toxicity occurred.ConclusionSBRT for liver metastases was well tolerated in this non-selected patient cohort and yielded good local control despite the considerable size of most lesions treated. Long-term survival is possible after SBRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0369-9) contains supplementary material, which is available to authorized users.
Highlights
Metastatic spread to the liver is quite a frequent event in the natural course of many common solid tumors [1,2,3]
It has been shown that long term survival can be achieved with surgical treatment of solitary liver metastases as the only site of distant relapse [4,5]
Patients with 1– 4 liver metastases irrespective of histology were eligible after discussion in a multidisciplinary tumorboard, which had recommended against other treatment modalities including surgery
Summary
Metastatic spread to the liver is quite a frequent event in the natural course of many common solid tumors [1,2,3]. Histology, and extent of hepatic lesion(s), the presence of additional uncontrolled metastatic spread profoundly affects prognosis. It has been shown that long term survival can be achieved with surgical treatment of solitary liver metastases as the only site of distant relapse [4,5]. Fiveyear survival rates in the order of 50% have been reported in highly selected patients [6]. A treatment strategy focusing on effective local treatment may be indicated after proper patient selection.
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