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Liver SBRT with active motion-compensation results in excellent local control for liver oligometastases: an outcome analysis of a pooled multi-platform patient cohort

Background - Local treatment of metastases in combination with systemic therapy can prolong survival of oligo-metastasized patients. To fully exploit this potential, safe and effective treatments are needed to ensure long-term metastases control. Stereotactic body radiotherapy (SBRT) is one means, h...

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Main Authors: Stera, Susanne (Author) , Miebach, Georgia (Author) , Bürgy, Daniel (Author) , Dreher, Constantin (Author) , Lohr, Frank (Author) , Wurster, Stefan (Author) , Rödel, Claus (Author) , Marcella, Szücs (Author) , Krug, David (Author) , Frank A., Giordano (Author) , Ehmann, Michael (Author) , Fleckenstein, Jens (Author) , Blanck, Oliver (Author) , Boda-Heggemann, Judit (Author)
Format: Article (Journal)
Language:English
Published: May 2021
In: Radiotherapy and oncology
Year: 2021, Volume: 158, Pages: 230-236
ISSN:1879-0887
DOI:10.1016/j.radonc.2021.02.036
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.radonc.2021.02.036
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0167814021061107
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Author Notes:Susanne Stera, Georgia Miebach, Daniel Buergy, Constantin Dreher, Frank Lohr, Stefan Wurster, Claus Rödel, Szücs Marcella, David Krug, Giordano Frank A., Michael Ehmann, Jens Fleckenstein, Oliver Blanck, Judit Boda-Heggemann
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Summary:Background - Local treatment of metastases in combination with systemic therapy can prolong survival of oligo-metastasized patients. To fully exploit this potential, safe and effective treatments are needed to ensure long-term metastases control. Stereotactic body radiotherapy (SBRT) is one means, however, for moving liver tumors correct delivery of high doses is challenging. After validating equal in-vivo treatment accuracy, we analyzed a pooled multi-platform liver-SBRT-database for clinical outcome. - Methods - Local control (LC), progression-free interval (PFI), overall survival (OS), predictive factors and toxicity was evaluated in 135 patients with 227 metastases treated by gantry-based SBRT (deep-inspiratory breath-hold-gating; n = 71) and robotic-based SBRT (fiducial-tracking, n = 156) with mean gross tumor volume biological effective dose (GTV-BEDα/β=10Gy) of 146.6 Gy10. - Results - One-, and five-year LC was 90% and 68.7%, respectively. On multivariate analysis, LC was significantly predicted by colorectal histology (p = 0.006). Median OS was 20 months with one- and two-year OS of 67% and 37%. On multivariate analysis, ECOG-status (p = 0.003), simultaneous chemotherapy (p = 0.003), time from metastasis detection to SBRT-treatment (≥2months; p = 0.021) and LC of the treated metastases (≥12 months, p < 0.009) were significant predictors for OS. One- and two-year PFI were 30.5% and 14%. Acute toxicity was mild and rare (14.4% grade I, 2.3% grade II, 0.6% grade III). Chronic °III/IV toxicities occurred in 1.1%. - Conclusions - Patient selection, time to treatment and sufficient doses are essential to achieve optimal outcome for SBRT with active motion compensation. Local control appears favorable compared to historical control. Long-term LC of the treated lesions was associated with longer overall survival.
Item Description:Gesehen am 17.09.2021
Physical Description:Online Resource
ISSN:1879-0887
DOI:10.1016/j.radonc.2021.02.036

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