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Stereotactic body radiation therapy using the CyberKnife(®) system for patients with liver metastases.

Yuan ZY, Meng MB, Liu CL, Wang HH, Jiang C, Song YC, Zhuang HQ, Yang D, Wang JS, Wei W, Li FT, Zhao LJ, Wang P - Onco Targets Ther (2014)

Bottom Line: Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events.The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001).Grade 1-2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, People's Republic of China.

ABSTRACT
The aim of this study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) in the treatment of patients with liver metastases. Between August 2006 and July 2011, patients with 1-4 liver metastases were enrolled and treated with SBRT using the CyberKnife(®) system at Tianjin Medical University Cancer Institute and Hospital. The metastases were from different primary tumors, with a maximum tumor diameter of less than 6 cm. The primary endpoint was local control. Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events. Fifty-seven patients with 80 lesions were treated with SBRT. The 1-year and 2-year local control rates were 94.4% and 89.7%, respectively. The difference in local control between patients who received adjuvant treatment before SBRT and those who did not reached statistical significance (P=0.049). The median overall survival for the entire cohort was 37.5 months. According to the primary tumor sites, the median overall survival was not reached. The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001). Grade 1-2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed. With excellent local control in the absence of severe toxicity, SBRT provides an alternative for patients with 1-4 liver metastases who cannot undergo surgery or other treatments.

No MeSH data available.


Related in: MedlinePlus

Representative planning CT and isodose distributions with SBRT for patients with 1–3 LM.Notes: Each representative patient had axial, sagittal, and coronal images taken, and red and purple lines indicate GTV and PTV, respectively. (A) A 38-year-old woman treated for a solitary LM from breast carcinoma. SBRT was performed using three fractions of 12 Gy prescribed to the 78% isodose line. (B) A 54-year-old man treated for two LM from rectal carcinoma. SBRT was performed using five fractions of 9 Gy to the 77% isodose line. (C) An 18-year-old man treated for three LM from pancreatic carcinoma. SBRT was performed in three fractions of 12 Gy to the 77% isodose line.Abbreviations: LM, liver metastasis; CT, computer tomography; GTV, gross tumor volume; PTV, planning target volume; Gy, Gray; SBRT, stereotactic body radiation therapy.
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f1-ott-7-915: Representative planning CT and isodose distributions with SBRT for patients with 1–3 LM.Notes: Each representative patient had axial, sagittal, and coronal images taken, and red and purple lines indicate GTV and PTV, respectively. (A) A 38-year-old woman treated for a solitary LM from breast carcinoma. SBRT was performed using three fractions of 12 Gy prescribed to the 78% isodose line. (B) A 54-year-old man treated for two LM from rectal carcinoma. SBRT was performed using five fractions of 9 Gy to the 77% isodose line. (C) An 18-year-old man treated for three LM from pancreatic carcinoma. SBRT was performed in three fractions of 12 Gy to the 77% isodose line.Abbreviations: LM, liver metastasis; CT, computer tomography; GTV, gross tumor volume; PTV, planning target volume; Gy, Gray; SBRT, stereotactic body radiation therapy.

Mentions: Details of the CyberKnife® treatment technique and its accuracy have been described in our previous publications.21–23 The prescribed dose and fractionation were specified according to lesion location and volume. Briefly, an average of five cylindrical gold fiducial markers (Best Medical International, Springfield, VA, USA) were placed percutaneously either under ultrasound guidance or CT guidance within or around the tumor at a minimum distance of 2 cm. Next, the patients were immobilized using a vacuum mattress before three-dimensional or four-dimensional CT simulation was used in the planning procedure. A set of planning CT images through the liver were obtained after infusion of intravenous radiographic contrast material to highlight the tumor. The images had to have enough margin above and below the tumor according to pretreatment planning CT, PET/CT, and magnetic resonance images. The gross target volume was defined as the liver metastasis and the planning target volume, with an accurate margin according to three-dimensional or four-dimensional CT simulation. The total dose delivered to the tumor and the fractionation schedule were determined by constraints regarding the adjacent normal tissues, as shown in Table 2, and three examples of the dose distribution are shown in Figure 1.


Stereotactic body radiation therapy using the CyberKnife(®) system for patients with liver metastases.

Yuan ZY, Meng MB, Liu CL, Wang HH, Jiang C, Song YC, Zhuang HQ, Yang D, Wang JS, Wei W, Li FT, Zhao LJ, Wang P - Onco Targets Ther (2014)

Representative planning CT and isodose distributions with SBRT for patients with 1–3 LM.Notes: Each representative patient had axial, sagittal, and coronal images taken, and red and purple lines indicate GTV and PTV, respectively. (A) A 38-year-old woman treated for a solitary LM from breast carcinoma. SBRT was performed using three fractions of 12 Gy prescribed to the 78% isodose line. (B) A 54-year-old man treated for two LM from rectal carcinoma. SBRT was performed using five fractions of 9 Gy to the 77% isodose line. (C) An 18-year-old man treated for three LM from pancreatic carcinoma. SBRT was performed in three fractions of 12 Gy to the 77% isodose line.Abbreviations: LM, liver metastasis; CT, computer tomography; GTV, gross tumor volume; PTV, planning target volume; Gy, Gray; SBRT, stereotactic body radiation therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061159&req=5

f1-ott-7-915: Representative planning CT and isodose distributions with SBRT for patients with 1–3 LM.Notes: Each representative patient had axial, sagittal, and coronal images taken, and red and purple lines indicate GTV and PTV, respectively. (A) A 38-year-old woman treated for a solitary LM from breast carcinoma. SBRT was performed using three fractions of 12 Gy prescribed to the 78% isodose line. (B) A 54-year-old man treated for two LM from rectal carcinoma. SBRT was performed using five fractions of 9 Gy to the 77% isodose line. (C) An 18-year-old man treated for three LM from pancreatic carcinoma. SBRT was performed in three fractions of 12 Gy to the 77% isodose line.Abbreviations: LM, liver metastasis; CT, computer tomography; GTV, gross tumor volume; PTV, planning target volume; Gy, Gray; SBRT, stereotactic body radiation therapy.
Mentions: Details of the CyberKnife® treatment technique and its accuracy have been described in our previous publications.21–23 The prescribed dose and fractionation were specified according to lesion location and volume. Briefly, an average of five cylindrical gold fiducial markers (Best Medical International, Springfield, VA, USA) were placed percutaneously either under ultrasound guidance or CT guidance within or around the tumor at a minimum distance of 2 cm. Next, the patients were immobilized using a vacuum mattress before three-dimensional or four-dimensional CT simulation was used in the planning procedure. A set of planning CT images through the liver were obtained after infusion of intravenous radiographic contrast material to highlight the tumor. The images had to have enough margin above and below the tumor according to pretreatment planning CT, PET/CT, and magnetic resonance images. The gross target volume was defined as the liver metastasis and the planning target volume, with an accurate margin according to three-dimensional or four-dimensional CT simulation. The total dose delivered to the tumor and the fractionation schedule were determined by constraints regarding the adjacent normal tissues, as shown in Table 2, and three examples of the dose distribution are shown in Figure 1.

Bottom Line: Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events.The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001).Grade 1-2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, People's Republic of China.

ABSTRACT
The aim of this study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) in the treatment of patients with liver metastases. Between August 2006 and July 2011, patients with 1-4 liver metastases were enrolled and treated with SBRT using the CyberKnife(®) system at Tianjin Medical University Cancer Institute and Hospital. The metastases were from different primary tumors, with a maximum tumor diameter of less than 6 cm. The primary endpoint was local control. Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events. Fifty-seven patients with 80 lesions were treated with SBRT. The 1-year and 2-year local control rates were 94.4% and 89.7%, respectively. The difference in local control between patients who received adjuvant treatment before SBRT and those who did not reached statistical significance (P=0.049). The median overall survival for the entire cohort was 37.5 months. According to the primary tumor sites, the median overall survival was not reached. The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001). Grade 1-2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed. With excellent local control in the absence of severe toxicity, SBRT provides an alternative for patients with 1-4 liver metastases who cannot undergo surgery or other treatments.

No MeSH data available.


Related in: MedlinePlus