Multicentre results of stereotactic body radiotherapy for secondary liver tumours.

BACKGROUND: Surgical resection is the standard treatment for liver metastases, although for the majority of patients this is not possible. Stereotactic body radiotherapy (SBRT) is an alternative local-regional therapy. The purpose of this study was to evaluate the results of SBRT for secondary liver tumours from a combined multicentre database. METHODS: Variables from patients treated with SBRT from four Academic Medical Centres were entered into a common database. Local tumour control and 1-year survival rates were calculated. RESULTS: In total, 153 patients (91 women) 59 ± 8.4 years old with 363 metastatic liver lesions were treated with SBRT. The underlying primary tumour arose from gastrointestinal (GI), retroperitoneal and from extra-abdominal primaries in 56%, 8% and 36% of patients, respectively. Metastases, with a gross tumour volume (GTV) of 138.5 ± 126.8 cm(3) , were treated with a total radiation dose of 37.5 ± 8.2 Gy in 5 ± 3 fractions. The 1-year overall survival was 51% with an overall local control rate of 62% at a mean follow-up of 25.2 ± 5.9 months. A complete tumour response was observed in 32% of patients. Grade 3-5 adverse events were noted in 3% of patients. CONCLUSION: Secondary liver tumours treated with SBRT had a high rate of local control with a low incidence of adverse events.

Emerging role of stereotactic body radiotherapy in the treatment of pancreatic cancer.

The management of pancreatic cancer continues to be challenging. Despite surgical, genetic and molecular advances, its overall prognosis remains poor. Surgical resection is the only modality that offers a chance for a cure, with an overall survival rate of 10-20% at 5 years. However, only 20% of the patients are surgical candidates because of locally advanced disease or systemic stage at presentation. Conventional radiotherapy, with or without chemotherapy, has been used to treat patients with advanced-stage pancreatic cancer, an approach with high rates of local recurrence. Stereotactic body radiation therapy, also known as stereotactic ablative radiotherapy has emerged as a treatment modality that allows the precise delivery of a large ablative radiation dose to a tumor volume while sparing surrounding organs and tissues. Phase I and II studies have shown good rates of local control of the disease but rates of distant metastasis remain significant. Strategies to combine novel systemic therapy and stereotactic body radiation therapy are to be explored.