Stereotactic Body Radiotherapy (SBRT) for liver metastasis - clinical outcomes from the international multi-institutional RSSearch® Patient Registry

Anand Mahadevan, Oliver Blanck, Rachelle Lanciano, Anuj Peddada, Srinath Sundararaman, David D'Ambrosio, Sanjeev Sharma, David Perry, James Kolker, Joanne Davis, Anand Mahadevan, Oliver Blanck, Rachelle Lanciano, Anuj Peddada, Srinath Sundararaman, David D'Ambrosio, Sanjeev Sharma, David Perry, James Kolker, Joanne Davis

Abstract

Background: Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international patient registry.

Methods: Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED10. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test.

Results: The study included 427 patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31-91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of patients received prior chemotherapy. Median tumor volume was 40 cm3 (1.6-877 cm3), median SBRT dose was 45 Gy (12-60 Gy) delivered in a median of 3 fractions [1-5]. At a median follow-up of 14 months (1-91 months) the median overall survival (OS) was 22 months. Median OS was greater for patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p < 0.0001). Smaller tumor volumes (< 40 cm3) correlated with improved OS (25 months vs 15 months p = 0.0014). BED10 ≥ 100 Gy was also associated with improved OS (27 months vs 15 months p < 0.0001). Local control (LC) was evaluable in 430 liver metastases from 324 patients. Two-year LC rates was better for BED10 ≥ 100 Gy (77.2% vs 59.6%) and the median LC was better for tumors < 40 cm3 (52 vs 39 months). There was no difference in LC based on histology of the primary tumor.

Conclusions: In a large, multi-institutional series of patients with liver metastasis treated with SBRT, reasonable LC and OS was observed. OS and LC depended on dose and tumor volume, while OS varied by primary tumor. Future prospective trials on the role of SBRT for liver metastasis from different primaries in the setting of multidisciplinary management including systemic therapy, is warranted.

Trial registration: Clinicaltrials.gov: NCT01885299 .

Keywords: Liver metastasis; RSSearch registry; SBRT.

Conflict of interest statement

Ethics approval and consent to participate

All participating institutions were required to have Institutional Review Board/Ethics Committee approval prior to entering patients into the registry.

All subjects were required to sign an informed consent specific for entry into the registry.

Consent for publication

Patient informed consent included consent for publication. All investigators provided consent for publication.

Competing interests

The authors do not have competing interest in the publication of this cumulative data.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overall survival (top panel) and local control (bottom panel) of patients with liver metastases treated with SBRT
Fig. 2
Fig. 2
Overall Survival (top panel) and local control (bottom panel) of liver metastases treated with SBRT shown by histology
Fig. 3
Fig. 3
Overall survival (top panel) and local control (bottom panel) of liver metastases treated with SBRT by target volume
Fig. 4
Fig. 4
Overall survival (top panel) and local control (bottom panel) of liver metastases by dose
Fig. 5
Fig. 5
Overall survival and local control of patients with liver metastases volumes 3 (a), (b) and ≥ 40 cm3 (c) and (d) by dose (≥ 100 BED vs. < 100 BED). Overall survival and local control are significantly better for tumors ≥ 40 cm3 treated with BED ≥ 100 compared to BED < 100 (panels C, (d)

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