Department of Radiation Oncology, Georgetown University Washington, DC, USA.
Front Oncol. 2012 Feb 2;2:8. doi: 10.3389/fonc.2012.00008. eCollection 2012.
Colorectal cancer (CRC) is the third leading cause of cancer-related death in the U.S. Many patients with CRC develop hepatic metastases as the sole site of metastases. Historical treatment options were limited to resection or conventional radiation therapy. Stereotactic body radiation therapy (SBRT) has emerged as a rational treatment approach. This study reviews our experience with SBRT for patients with liver metastases from CRC.
Fourteen histologically confirmed hepatic CRC metastases in 11 consecutive patients were identified between November, 2004 and June, 2009 at Georgetown University. All patients underwent CT-based treatment planning; a few also had MRI or PET/CT. All patients had fiducial markers placed under CT guidance and were treated using the CyberKnife system. Treatment response and toxicities were examined; survival and local control were evaluated.
Most patients were treated to a single hepatic lesion (n = 8), with a few treated to two lesions (n = 3). Median treatment volume was 99.7 cm(3), and lesions were treated to a median BED(10) of 49.7 Gy (range: 28-100.8 Gy). Median follow-up was 21 months; median survival was 16.1 months, with 2 year actuarial survival of 25.7%. One year local control was 72%. Among patients with post-treatment imaging, eight had stable disease (80%) and two had progressive disease (20%) at first follow-up. The most common grade 1-2 acute toxicities included nausea and alterations in liver function tests; there was one grade 3 toxicity (elevated bilirubin), and no grade 4-5 toxicities.
SBRT is safe and feasible for the treatment of limited hepatic metastases from CRC. Our results compare favorably with outcomes from previous studies of SBRT. Further studies are needed to better define patient eligibility, study the role of combined modality treatment, optimize treatment parameters, and characterize quality of life after treatment.
结直肠癌（CRC）是美国癌症相关死亡的第三大主要原因。许多 CRC 患者发展为肝转移，且转移灶仅限于肝脏。历史上的治疗选择仅限于手术切除或常规放射治疗。立体定向体部放射治疗（SBRT）已成为一种合理的治疗方法。本研究回顾了我们使用 SBRT 治疗结直肠癌肝转移患者的经验。
2004 年 11 月至 2009 年 6 月，乔治敦大学共发现 11 例连续患者的 14 例经组织学证实的肝 CRC 转移灶。所有患者均接受 CT 引导下的治疗计划；少数患者还接受 MRI 或 PET/CT。所有患者均在 CT 引导下放置了基准标记，并使用 CyberKnife 系统进行治疗。检查治疗反应和毒性；评估生存和局部控制情况。
大多数患者接受了单一肝病变的治疗（n=8），少数患者接受了两个病变的治疗（n=3）。中位治疗体积为 99.7cm3，病变接受了中位 BED（10）49.7Gy（范围：28-100.8Gy）的治疗。中位随访时间为 21 个月；中位生存期为 16.1 个月，2 年生存率为 25.7%。1 年局部控制率为 72%。在有治疗后影像学检查的患者中，8 例在首次随访时疾病稳定（80%），2 例疾病进展（20%）。最常见的 1-2 级急性毒性包括恶心和肝功能检查改变；有 1 例 3 级毒性（胆红素升高），无 4-5 级毒性。
SBRT 治疗结直肠癌肝转移是安全可行的。我们的结果与 SBRT 既往研究的结果相比是有利的。需要进一步的研究来更好地确定患者的适宜性，研究联合治疗的作用，优化治疗参数，并描述治疗后的生活质量。
