Stereotactic body radiotherapy (SBRT) in combination with surgery for primary and metastatic liver tumors.

347 Background: Evaluate the feasibility, safety, and efficacy of SBRT in combination with surgery for primary and metastatic liver tumors. Methods: 12 patients completed hepatectomy and SBRT for either hepatocellular carcinoma (HCC) (3) or metastases from colorectal (4), neuroendocrine (2), uterine (2), or sarcoma (1) primary. All patients with metastases completed chemotherapy. Most patients (7) had resection of their operable metastases, total of 19, and gold fiducials placed in the unresectable lesions, total of 9, to facilitate definitive adjuvant SBRT. One patient with an unresectable metastasis received preoperative SBRT. Two patients with HCC had SBRT as a bridge to liver transplant. Two patients had salvage SBRT for recurrence after surgery. All patients completed 4D-CT for ITV definition and SPECT/CT to define functional normal liver parenchyma volume (NLV). MV-fluoro was performed to confirm tumor/fiducial respiratory motion within the PTV. Results: All patients successfully completed a combination of hepatectomy and SBRT. Seventeen hepatic lesions (≤ 2/patient) were treated with SBRT with a mean PTV 186.0 cc (15.1-803.5). The mean dose was 49.3 Gy (39-60) prescribed to the PTV in 5-6 fractions. With median follow-up of 9.2 months (2.8-15.3) there was no RILD > Grade 1 observed. The most common toxicity was Grade ≤ 2 fatigue. Nine patients had reduced SPECT-NLV vs. calculated NLV by a mean of 487.5 cc (p = 0.0004). In 6 of these, the SPECT-NLV vs. the CT-NLV was reduced by a mean of 253.9 cc (44.6 - 1076.2) reflecting the importance of SPECT functional imaging for SBRT planning. Postoperative morbidity was ≤ Grade 1. All surgical margins were negative. Three patients developed intrahepatic failures post SBRT. However, on follow-up imaging no in-field failures have occurred. Conclusions: The combination of liver SBRT with hepatic resection is safe and effective. It can be used preoperatively to increase resectability or to salvage surgical failures. We also report on the combination of limited hepatectomy for peripheral (including bilobar) hepatic metastases with planned SBRT to unresectable metastatic lesion(s). SBRT planning with SPECT/CT allows identification and preservation of the NLV.

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Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.360 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 360-360

Author(s):

Alexander V. Kirichenko ◽

David S. Parda ◽

Angela Sanguino ◽

Olivier Gayou ◽

Moses S. Raj ◽

...

Keyword(s):

Liver Transplant ◽

Local Control ◽

Liver Tumors ◽

Perioperative Complications ◽

Liver Volume ◽

Hepatic Metastases ◽

Tumor Diameter ◽

Liver Sbrt ◽

Metastatic Liver Tumors ◽

Metastatic Liver

360 Background: We report on the outcome and toxicity of liver SBRT alone or in combination with surgery for inoperable primary and metastatic liver tumors. Methods: Patients with up to four isolated hepatic metastases (sum of tumor diameters ≤ 8cm) and individual tumor diameter ≤ 9 cm received SBRT at 46.8Gy ± 3.7 in 4-6 fractions. In patients with hepatic cirrhosis, liver dose constraints were imposed exclusively on residual functional liver volume defined on SPECT during SBRT treatment planning. The primary end point was local control with at least 6 months of radiographic followup, and secondary end points were toxicity and survival. Results: Between 2007-2014, 120 lesions in 91 patients with either unresectable primary (n = 43) or metastatic liver cancer (n = 48) completed liver SBRT to 36-60 Gy delivered in 4 to 6 treatment fractions, with a mean BED of 197 Gy3 (range 108 – 300 Gy3). Median followup was 20.3 months (range 1.9 - 64.1). Fourteen patients underwent liver transplant with SBRT as a bridging therapy or for tumor downsizing. Eight patients completed hepatic resections in combination with planned SBRT for unresectable tumors. Two-year local control was 96% for hepatoma and 93.8% for metastases; it was 100% for lesions ≤ 4cm. Ten of 14 transplanted patients developed complete pathological response with median time to transplant of 5.7 months (range 1.7 – 23.3). No incidence of grade > 2 treatment toxicity was observed. There was no accelerated Child-Pugh class migration from A to B or from B to C. There were no operative or perioperative complications in patients who received SBRT prior to liver transplant or in combination with planned hepatectomy. Two-year overall survival was 82.3% (hepatoma) and 64.3% (metastases). Conclusions: In this retrospective analysis we demonstrate that liver SBRT alone or in combination with surgery is safe and effective for the treatment of isolated inoperable hepatic malignancies and provides excellent local control rates with minimal toxicity.

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