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Original Article

Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors

Rafael A. IbarraDepartment of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Daniel RojasDepartment of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Laura SnyderDepartment of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Min YaoDepartment of Radiation Oncology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Jeffrey FabienDepartment of Radiation Oncology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Michael MilanoUniversity of Rochester Medical Center, Rochester, New York, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Alan KatzUniversity of Rochester Medical Center, Rochester, New York, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Karyn GoodmanMemorial Sloan-Kettering Cancer Center, New York;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Kevin StephansCleveland Clinic, Case Western Reserve University & Lerner College of Medicine, Cleveland, OH;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Galal El-GazzazCleveland Clinic, Case Western Reserve University & Lerner College of Medicine, Cleveland, OH;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Federico AucejoCleveland Clinic, Case Western Reserve University & Lerner College of Medicine, Cleveland, OH;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Charles MillerCleveland Clinic, Case Western Reserve University & Lerner College of Medicine, Cleveland, OH;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

John FungCleveland Clinic, Case Western Reserve University & Lerner College of Medicine, Cleveland, OH;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Simon LoDepartment of Radiation Oncology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Mitchell MachtayDepartment of Radiation Oncology, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA

Juan R. SanabriaDepartment of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio, USA;Department of Medicine, University Hospitals-Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USACorrespondence[email protected] [email protected]

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Abstract

Background. An excess of 100 000 individuals are diagnosed with primary liver tumors every year in USA but less than 20% of those patients are amenable to definitive surgical management due to advanced local disease or comorbidities. Local therapies to arrest tumor growth have limited response and have shown no improvement on patient survival. Stereotactic body radiotherapy (SBRT) has emerged as an alternative local ablative therapy. The purpose of this study was to evaluate the tumor response to SBRT in a combined multicenter database. Study design. Patients with advanced hepatocellular carcinoma (HCC, n = 21) or intrahepatic cholangiocarcinoma (ICC, n = 11) treated with SBRT from four Academic Medical Centers were entered into a common database. Statistical analyses were performed for freedom from local progression (FFLP) and patient survival. Results. The overall FFLP for advanced HCC was 63% at a median follow-up of 12.9 months. Median tumor volume decreased from 334.2 to 135 cm³ (p < 0.004). The median time to local progression was 6.3 months. The 1- and 2-years overall survival rates were 87% and 55%, respectively. Patients with ICC had an overall FFLP of 55.5% at a median follow-up of 7.8 months. The median time to local progression was 4.2 months and the six-month and one-year overall survival rates were 75% and 45%, respectively. The incidence of grade 1–2 toxicities, mostly nausea and fatigue, was 39.5%. Grade 3 and 4 toxicities were present in two and one patients, respectively. Conclusion. Higher rates of FFLP were achieved by SBRT in the treatment of primary liver malignancies with low toxicity.

Acknowledgments

We are grateful to the staff and residents in the Department of Radiation Oncology, University Hospitals-Case Medical Center, Cleveland, Ohio. Rafael A. Ibarra was supported by a Ruth L. Kirschstein National Research Service Award NIH/NIDDK (T32-DK007319). This work was presented at the American Society of Transplant Surgeons (ASTS), Philadelphia, USA, 2011, the International Liver Transplant Society (ILTS), Valencia, Spain, 2011, and the International Liver Cancer Association (ILCA), Hong-Kong, China, 2011.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

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Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors

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Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors

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