Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies Journal Article


Authors: Goodman, K. A.; Wiegner, E. A.; Maturen, K. E.; Zhang, Z.; Mo, Q.; Yang, G.; Gibbs, I. C.; Fisher, G. A.; Koong, A. C.
Article Title: Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies
Abstract: Purpose: We performed a Phase I dose-escalation study to explore the feasibility and safety of treating primary and metastatic liver tumors with single-fraction stereotactic body radiotherapy (SBRT). Methods and Materials: Between February 2004 and February 2008, 26 patients were treated for 40 identifiable lesions. Nineteen patients had hepatic metastases, 5 had intrahepatic cholangiocarcinomas, and 2 had recurrent hepatocellular carcinomas. The prescribed radiation dose was escalated from 18 to 30 Gy at 4-Gy increments with a planned maximum dose of 30 Gy. Cumulative incidence functions accounted for competing risks to estimate local failure (LF) incidence over time under the competing risk of death. Results: All patients tolerated the single-fraction SBRT well without developing a dose-limiting toxicity. Nine acute Grade 1 toxicities, one acute Grade 2 toxicity, and two late Grade 2 gastrointestinal toxicities were observed. After a median of 17 months follow-up (range, 2-55 months), the cumulative risk of LF at 12 months was 23%. Fifteen patients have died: 11 treated for liver metastases and 4 with primary liver tumors died. The median survival was 28.6 months, and the 2-year actuarial overall survival was 50.4%. Conclusions: It is feasible and safe to deliver single-fraction, high-dose SBRT to primary or metastatic liver malignancies measuring ≤5 cm. Moreover, single-fraction SBRT for liver lesions demonstrated promising local tumor control with minimal acute and long-term toxicity. Single-fraction SBRT appears to be a viable nonsurgical option, but further studies are warranted to evaluate both control rates and impact on quality of life. Copyright © 2010 Elsevier Inc. Printed in the USA. All rights reserved.
Keywords: adult; cancer survival; clinical article; aged; aged, 80 and over; middle aged; survival analysis; primary tumor; treatment failure; young adult; overall survival; liver cell carcinoma; carcinoma, hepatocellular; liver neoplasms; cancer radiotherapy; follow up; follow-up studies; cancer incidence; quality control; neoplasm recurrence, local; radiotherapy dosage; radiotherapy; pathology; gastrointestinal toxicity; liver metastasis; liver; feasibility study; tumors; feasibility studies; tumor burden; radiation dose fractionation; radiosurgery; patient safety; radiation injuries; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; stereotactic body radiotherapy; toxicity; acute toxicity; stereotactic body radiation therapy; observation; liver metastases; abdominal radiotherapy; primary liver tumors; population statistics; risk perception; duodenal ulcer
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 78
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2010-10-01
Start Page: 486
End Page: 493
Language: English
DOI: 10.1016/j.ijrobp.2009.08.020
PUBMED: 20350791
PROVIDER: scopus
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus"
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MSK Authors
  1. Qianxing Mo
    37 Mo
  2. Zhigang Zhang
    325 Zhang
  3. Karyn A Goodman
    255 Goodman