Repeated SBRT for in- and out-of-field recurrences in the liver.
Strahlenther Onkol
; 195(3): 246-253, 2019 Mar.
Article
em En
| MEDLINE
| ID: mdl-30353350
ABSTRACT
PURPOSE:
To evaluate the feasibility and toxicity profile of repeated stereotactic body radiotherapy (SBRT) for recurrent primary or secondary liver tumors.METHODS:
Consecutive patients with primary (hepatocellular carcinoma [HCC] or cholangiocarcinoma [CCC]) or secondary liver cancer (LM), with intrahepatic recurrence or progression after SBRT, underwent re-SBRT in 3 to 12 fractions with a median time of 15 (range 2-66) months between treatments.RESULTS:
In all, 24 patients which were previously treated with SBRT (30 lesions) were retreated with SBRT for "in- and out-of-field" recurrences (2nd SBRT nâ¯= 28, 3rd SBRT nâ¯= 2). The median follow-up after re-irradiation was 14 months. The median prescribed dose for the first SBRT was 46.5 (range 33-66â¯Gy, EQD210â¯= 70.5) Gy and 48 (range 27-66â¯Gy, EQD210â¯= 71) Gy for the re-SBRT. The median mean liver dose (Dmean, liver) was 6â¯Gy (range 1-25, EQD22â¯= 7â¯Gy) for the first SBRT and 10â¯Gy (range 1-63â¯Gy, EQD22â¯= 9â¯Gy) for the re-SBRT. Of the 30 re-irradiated lesions 6 were re-irradiated in-field resulting in a median EQD22, maximum of 359 (range 120-500) Gy for both treatments, with an α/ßâ¯= 2 to account for liver parenchyma. Treatment was well tolerated. Two patients with stent placement before SBRT developed cholangitis 4 and 14 months after re-SBRT. There were no elevations of the serum liver parameters after re-SBRT. One patient developed a grade 3 gastrointestinal bleeding. There was no radiation induced liver disease (RILD) observed.CONCLUSIONS:
Repeated liver SBRT is feasible, without excessive liver toxicity, when there is no considerable overlapping with pre-irradiated portions of the stomach or bowel and enough time for the liver to regenerate.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Neoplasias dos Ductos Biliares
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Radiocirurgia
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Colangiocarcinoma
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Carcinoma Hepatocelular
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Neoplasias Hepáticas
Tipo de estudo:
Observational_studies
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Prognostic_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article