Local Control After Stereotactic Body Radiation Therapy for Liver Tumors

Nitin Ohri, Wolfgang A Tomé, Alejandra Méndez Romero, Moyed Miften, Randall K Ten Haken, Laura A Dawson, Jimm Grimm, Ellen Yorke, Andrew Jackson, Nitin Ohri, Wolfgang A Tomé, Alejandra Méndez Romero, Moyed Miften, Randall K Ten Haken, Laura A Dawson, Jimm Grimm, Ellen Yorke, Andrew Jackson

Abstract

Purpose: To quantitatively evaluate published experiences with hepatic stereotactic body radiation therapy (SBRT), to determine local control rates after treatment of primary and metastatic liver tumors and to examine whether outcomes are affected by SBRT dosing regimen.

Methods and materials: We identified published articles that reported local control rates after SBRT for primary or metastatic liver tumors. Biologically effective doses (BEDs) were calculated for each dosing regimen using the linear-quadratic equation. We excluded series in which a wide range of BEDs was used. Individual lesion data for local control were extracted from actuarial survival curves, and data were aggregated to form a single dataset. Actuarial local control curves were generated using the Kaplan-Meier method after grouping lesions by disease type and BED (<100 Gy10 vs >100 Gy10). Comparisons were made using log-rank testing.

Results: Thirteen articles met all inclusion criteria and formed the dataset for this analysis. The 1-, 2-, and 3-year actuarial local control rates after SBRT for primary liver tumors (n = 431) were 93%, 89%, and 86%, respectively. Lower 1- (90%), 2- (79%), and 3-year (76%) actuarial local control rates were observed for liver metastases (n = 290, log-rank P = .011). Among patients treated with SBRT for primary liver tumors, there was no evidence that local control is influenced by BED within the range of schedules used. For liver metastases, on the other hand, outcomes were significantly better for lesions treated with BEDs exceeding 100 Gy10 (3-year local control 93%) than for those treated with BEDs of ≤100 Gy10 (3-year local control 65%, P < .001).

Conclusions: Stereotactic body radiation therapy for primary liver tumors provides high rates of durable local control, with no clear evidence for a dose-response relationship among commonly utilized schedules. Excellent local control rates are also seen after SBRT for liver metastases when BEDs of >100 Gy10 are utilized.

Conflict of interest statement

Conflict of interest: none.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier curves for local control of primary and metastatic liver tumors after stereotactic body radiation therapy. Abbreviations: CCA Z cholangiocarcinoma; HCC Z hepatocellular carcinoma.
Fig. 2.
Fig. 2.
Kaplan-Meier curves for local control of primary liver tumors after stereotactic body radiation therapy, after grouping patients by biologically effective dose (BED). Abbreviations: CCA Z cholangiocarcinoma; HCC Z hepatocellular carcinoma.
Fig. 3.
Fig. 3.
Kaplan-Meier curves for local control of meta-static liver tumors after stereotactic body radiation therapy, after grouping patients by biologically effective dose (BED).
Fig. 4.
Fig. 4.
Tumor control probability modeling results for actuarial local control of metastatic liver tumors two years after stereotactic body radiation therapy. Black circles represent mean biologically effective dose (BED) and 2-year actuarial local control for 4 groups after sorting by BED. Circle size is proportional to sample size, and vertical lines span 95% confidence intervals for 2-year actuarial local control in each group. The solid curve depicts the results of model fitting using all available data. Grey lines represent model fitting results for 5000 bootstrap iterations. Dotted black lines indicate 95% confidence bounds for tumor control probability as a function of BED.

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