Hypofractionated image-guided breath-hold SABR (Stereotactic Ablative Body Radiotherapy) of liver metastases -clinical results

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• 作者：Judit Boda-Heggemann (1) (5)
  Dietmar Dinter (2)
  Christel Weiss (3)
  Anian Frauenfeld (1)
  Kerstin Siebenlist (1)
  Ulrike Attenberger (2)
  Martine Ottstadt (1)
  Frank Schneider (1)
  Ralf-Dieter Hofheinz (4)
  Frederik Wenz (1)
  Frank Lohr (1)
  
• 关键词：Hypofractionated image ; guided breath ; hold SABR ; Liver metastases ; Local control ; Survival ; Toxicity
• 刊名：Radiation Oncology
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：7
• 期：1
• 全文大小：649KB
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• 作者单位：Judit Boda-Heggemann (1) (5)
  Dietmar Dinter (2)
  Christel Weiss (3)
  Anian Frauenfeld (1)
  Kerstin Siebenlist (1)
  Ulrike Attenberger (2)
  Martine Ottstadt (1)
  Frank Schneider (1)
  Ralf-Dieter Hofheinz (4)
  Frederik Wenz (1)
  Frank Lohr (1)
  
  1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  5. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
  2. Institute of Diagnostic Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  3. Department of Biomathematics and Medical Statistics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  4. III. Department of Internal Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  

文摘

Purpose Stereotactic Ablative Body Radiotherapy (SABR) is a non-invasive therapy option for inoperable liver oligometastases. Outcome and toxicity were retrospectively evaluated in a single-institution patient cohort who had undergone ultrasound-guided breath-hold SABR. Patients and methods 19 patients with liver metastases of various primary tumors consecutively treated with SABR (image-guidance with stereotactic ultrasound in combination with computer-controlled breath-hold) were analysed regarding overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC), acute and late toxicity. Results PTV (planning target volume)-size was 108?±-09cm3 (median 67.4?cm3). BED2 (Biologically effective dose in 2?Gy fraction) was 83.3?±-6.2?Gy (median 78?Gy). Median follow-up and median OS were 12?months. Actuarial 2-year-OS-rate was 31%. Median PFS was 4?months, actuarial 1-year-PFS-rate was 20%. Site of first progression was predominantly distant. Regression of irradiated lesions was observed in 84% (median time to detection of regression was 2?months). Actuarial 6-month-LC-rate was 92%, 1- and 2-years-LC-rate 57%, respectively. BED2 influenced LC. When a cut-off of BED2--8?Gy was used, the higher BED2 values resulted in improved local control with a statistical trend to significance (p--.0999). Larger PTV-sizes, inversely correlated with applied dose, resulted in lower local control, also with a trend to significance (p-value--.08) when a volume cut-off of 67?cm3 was used. No local relapse was observed at PTV-sizes-lt;-7?cm3 and BED2-gt;-8?Gy. No acute clinical toxicity-gt;?? was observed. Late toxicity was also?≤?? with the exception of one gastrointestinal bleeding-episode 1?year post-SABR. A statistically significant elevation in the acute phase was observed for alkaline-phosphatase; in the chronic phase for alkaline-phosphatase, bilirubine, cholinesterase and C-reactive protein. Conclusions A trend to statistically significant correlation of local progression was observed for BED2 and PTV-size. Dose-levels BED2-gt;-8?Gy cannot be reached in large lesions constituting a significant fraction of this series. Image-guided SABR (igSABR) is therefore an effective non-invasive treatment modality with low toxicity in patients with small inoperable liver metastases.