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Stereotactic ablative radiotherapy for oligometastatic disease in liver.

Kim M, Son SH, Won YK, Kay CS - Biomed Res Int (2014)

Bottom Line: Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function.Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years.And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon-si, Seoul 403-720, Republic of Korea.

ABSTRACT
Liver metastasis in solid tumors, including colorectal cancer, is the most frequent and lethal complication. The development of systemic therapy has led to prolonged survival. However, in selected patients with a finite number of discrete lesions in liver, defined as oligometastatic state, additional local therapies such as surgical resection, radiofrequency ablation, cryotherapy, and radiotherapy can lead to permanent local disease control and improve survival. Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function. In recent years, the introduction of stereotactic ablative radiotherapy (SABR) has offered even more intensive tumor dose escalation in a few fractions with reduced dose to the adjacent normal liver. Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years. And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities. In this paper, we described the definition and technical aspects of SABR, clinical outcomes including efficacy and toxicity, and related parameters after SABR in liver oligometastases from colorectal cancer.

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Related in: MedlinePlus

A 52-year-old male patient had been treated with surgery and postoperative adjuvant chemotherapy for sigmoid colon cancer (adenocarcinoma, T2N2M0). 13 months later, liver metastasis developed and he was then treated with salvage chemotherapy; however, follow-up CT scan after the chemotherapy showed progression of liver metastasis (white arrows) (a). We decided to treat him with SABR. The prescriptive dose to the planning target volume including two metastatic tumor lesions was 40 Gy in 4 fractions on consecutive day (b). The CT scan on 3 months after the completion of SABR showed complete response (c). Radiotherapy related change of increased density around the previous tumor lesions was shown but the patient's liver function test was normal.
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fig2: A 52-year-old male patient had been treated with surgery and postoperative adjuvant chemotherapy for sigmoid colon cancer (adenocarcinoma, T2N2M0). 13 months later, liver metastasis developed and he was then treated with salvage chemotherapy; however, follow-up CT scan after the chemotherapy showed progression of liver metastasis (white arrows) (a). We decided to treat him with SABR. The prescriptive dose to the planning target volume including two metastatic tumor lesions was 40 Gy in 4 fractions on consecutive day (b). The CT scan on 3 months after the completion of SABR showed complete response (c). Radiotherapy related change of increased density around the previous tumor lesions was shown but the patient's liver function test was normal.

Mentions: The main goal of SABR is to achieve local control of each oligometastatic site; however, whether obtaining local control of the metastasis would translate into clinical or survival benefit for the patients depends on multiple factors, including age, performance status, medical comorbidities, and histology of malignancies. Therefore, careful and strict patient selection is needed and the patient's whole condition should be fully considered. Ideal candidates for SABR may be defined as follows: a limited number of metastases (one to five), a limited tumor size (<6 cm), a locally controlled primary site, metachronous occurrence of metastatic disease, favorable histologies (such as CRC and breast cancer), young age, good performance status, at least 700 m of uninvolved liver volume, and adequate pretreatment baseline liver function. In general, the risk of occult diffuse metastases increases as the number of metastases increases, and the best results are found in patients with 3 or fewer metastases, ideally less than 6 cm in maximum diameter [35, 36]. Figure 2 shows the case of good candidate for SABR in liver oligometastases.


Stereotactic ablative radiotherapy for oligometastatic disease in liver.

Kim M, Son SH, Won YK, Kay CS - Biomed Res Int (2014)

A 52-year-old male patient had been treated with surgery and postoperative adjuvant chemotherapy for sigmoid colon cancer (adenocarcinoma, T2N2M0). 13 months later, liver metastasis developed and he was then treated with salvage chemotherapy; however, follow-up CT scan after the chemotherapy showed progression of liver metastasis (white arrows) (a). We decided to treat him with SABR. The prescriptive dose to the planning target volume including two metastatic tumor lesions was 40 Gy in 4 fractions on consecutive day (b). The CT scan on 3 months after the completion of SABR showed complete response (c). Radiotherapy related change of increased density around the previous tumor lesions was shown but the patient's liver function test was normal.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020541&req=5

fig2: A 52-year-old male patient had been treated with surgery and postoperative adjuvant chemotherapy for sigmoid colon cancer (adenocarcinoma, T2N2M0). 13 months later, liver metastasis developed and he was then treated with salvage chemotherapy; however, follow-up CT scan after the chemotherapy showed progression of liver metastasis (white arrows) (a). We decided to treat him with SABR. The prescriptive dose to the planning target volume including two metastatic tumor lesions was 40 Gy in 4 fractions on consecutive day (b). The CT scan on 3 months after the completion of SABR showed complete response (c). Radiotherapy related change of increased density around the previous tumor lesions was shown but the patient's liver function test was normal.
Mentions: The main goal of SABR is to achieve local control of each oligometastatic site; however, whether obtaining local control of the metastasis would translate into clinical or survival benefit for the patients depends on multiple factors, including age, performance status, medical comorbidities, and histology of malignancies. Therefore, careful and strict patient selection is needed and the patient's whole condition should be fully considered. Ideal candidates for SABR may be defined as follows: a limited number of metastases (one to five), a limited tumor size (<6 cm), a locally controlled primary site, metachronous occurrence of metastatic disease, favorable histologies (such as CRC and breast cancer), young age, good performance status, at least 700 m of uninvolved liver volume, and adequate pretreatment baseline liver function. In general, the risk of occult diffuse metastases increases as the number of metastases increases, and the best results are found in patients with 3 or fewer metastases, ideally less than 6 cm in maximum diameter [35, 36]. Figure 2 shows the case of good candidate for SABR in liver oligometastases.

Bottom Line: Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function.Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years.And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon-si, Seoul 403-720, Republic of Korea.

ABSTRACT
Liver metastasis in solid tumors, including colorectal cancer, is the most frequent and lethal complication. The development of systemic therapy has led to prolonged survival. However, in selected patients with a finite number of discrete lesions in liver, defined as oligometastatic state, additional local therapies such as surgical resection, radiofrequency ablation, cryotherapy, and radiotherapy can lead to permanent local disease control and improve survival. Among these, an advance in radiation therapy made it possible to deliver high dose radiation to the tumor more accurately, without impairing the liver function. In recent years, the introduction of stereotactic ablative radiotherapy (SABR) has offered even more intensive tumor dose escalation in a few fractions with reduced dose to the adjacent normal liver. Many studies have shown that SABR for oligometastases is effective and safe, with local control rates widely ranging from 50% to 100% at one or two years. And actuarial survival at one and two years has been reported ranging from 72% to 94% and from 30% to 62%, respectively, without severe toxicities. In this paper, we described the definition and technical aspects of SABR, clinical outcomes including efficacy and toxicity, and related parameters after SABR in liver oligometastases from colorectal cancer.

Show MeSH
Related in: MedlinePlus