Presented at the American Society for Radiation Oncology Annual Meeting, San Diego, California, October 31-November 4, 2010.
Stereotactic body radiotherapy for colorectal liver metastases†
A pooled analysis
Version of Record online: 22 MAR 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 17, pages 4060–4069, 1 September 2011
How to Cite
Chang, D. T., Swaminath, A., Kozak, M., Weintraub, J., Koong, A. C., Kim, J., Dinniwell, R., Brierley, J., Kavanagh, B. D., Dawson, L. A. and Schefter, T. E. (2011), Stereotactic body radiotherapy for colorectal liver metastases. Cancer, 117: 4060–4069. doi: 10.1002/cncr.25997
- Issue online: 19 AUG 2011
- Version of Record online: 22 MAR 2011
- Manuscript Accepted: 28 DEC 2010
- Manuscript Revised: 5 OCT 2010
- Manuscript Received: 13 JUL 2010
Vol. 118, Issue 10, 2776, Version of Record online: 20 SEP 2011
- stereotactic body radiotherapy;
This study was undertaken to determine outcomes of stereotactic body radiotherapy for colorectal liver metastases in a pooled patient cohort.
Patients with colorectal liver metastases from 3 institutions were included if they had 1 to 4 lesions, received 1 to 6 fractions of stereotactic body radiotherapy, and had radiologic imaging ≥3 months post-treatment. Sixty-five patients with 102 lesions treated from August 2003 to May 2009 were retrospectively analyzed. A tumor control probability (TCP) model was used to estimate the 3-fraction dose required for >90% local control after converting the schedule into biologically equivalent dose (BED), single-fraction equivalent dose, or linear quadratic model-based single-fraction dose.
Forty-seven (72%) patients had ≥1 chemotherapy regimen before stereotactic body radiotherapy, and 27 (42%) patients had ≥2 regimens. The median follow-up was 1.2 years (range, 0.3-5.2 years). The median dose was 42 gray (Gy; range, 22-60 Gy). When evaluated separately by multivariate analysis, total dose (P = .0015), dose/fraction (P = .003), and BED (P = .004) all correlated with local control by lesion. On multivariate analysis, nonactive extrahepatic disease was associated with overall survival (OS; P = .046), and sustained local control was closely correlated (P = .06). By using single-fraction equivalent dose, BED, or linear quadratic model-based single-fraction dose in the TCP model, the estimated dose range needed for 1-year local control >90% is 46 to 52 Gy in 3 fractions.
Liver stereotactic body radiotherapy is well tolerated and effective for colorectal liver metastases. The strong correlation between local control and OS supports controlling hepatic disease even for heavily pretreated patients. For a 3-fraction regimen of stereotactic body radiotherapy, a prescription dose of ≥48 Gy should be considered, if normal tissue constraints allow. Cancer 2011. © 2011 American Cancer Society.