Andratschke Nicolaus Hj, Nieder Carsten, Heppt Franz, Molls Michael, Zimmermann Frank
Current Address: Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8006, Zurich, Switzerland.
Department of Radiation Oncology, University of Rostock, Rostock, Germany.
Radiat Oncol. 2015 Mar 20;10:69. doi: 10.1186/s13014-015-0369-9.
To report on outcome and toxicity of stereotactic body radiotherapy (SBRT) for liver metastases in patients not eligible for surgery.
From 2000 to 2009, 74 patients with 91 liver metastases from different primaries have been treated with SBRT at our institution. Median planning target volume was 123 ccm (range: 10.6-1074 ccm). Treatment consisted of 3-5 fractions with 5-12.5 Gy/ fraction prescribed to the surrounding 60-95% isodose with daily image guidance. Regular follow-up included CT or MRI imaging until tumor progression.
Median local recurrence-free interval was 23 months with a local control rate of 74.7%, 48.3% and 48.3% after 1, 2 and 3 years. Only minimum biologically effective dose (BED) to gross tumor volume (GTV) remained as independent significant factor for local control in multivariate analysis. No local recurrences were observed in lesions (n = 12) which received a minimal BED to the GTV of 120 Gy. Including 26 local recurrences, 67 patients (91%) showed disease progression after SBRT with a median time of 5 months. Median overall survival was 27 months with survival rates of 77%, 30% and 27% at 1, 3 and 5 years. On multivariate analysis only GTV volume remained as independent significant prognostic factor for overall survival (p = 0.002). No grade 3 to 5 acute toxicity and no grade 4 or 5 late toxicity occurred.
SBRT for liver metastases was well tolerated in this non-selected patient cohort and yielded good local control despite the considerable size of most lesions treated. Long-term survival is possible after SBRT.
报告立体定向体部放疗（SBRT）治疗无法手术的肝转移患者的疗效和毒性。
2000年至2009年，我院对74例来自不同原发肿瘤的91处肝转移灶患者进行了SBRT治疗。计划靶体积中位数为123立方厘米（范围：10.6 - 1074立方厘米）。治疗采用3 - 5次分割，每次5 - 12.5 Gy，处方剂量给予周围60 - 95%等剂量线，并进行每日图像引导。定期随访包括CT或MRI成像，直至肿瘤进展。
局部无复发生存期中位数为23个月，1年、2年和3年后的局部控制率分别为74.7%、48.3%和48.3%。多因素分析中，仅肿瘤总体积（GTV）的最小生物等效剂量（BED）是局部控制的独立显著因素。GTV最小BED为120 Gy的12处病灶未观察到局部复发。包括26例局部复发，67例（91%）患者在SBRT后出现疾病进展，中位时间为5个月。总生存期中位数为27个月，1年、3年和5年生存率分别为77%、30%和27%。多因素分析中，仅GTV体积是总生存期的独立显著预后因素（p = 0.002）。未发生3 - 5级急性毒性反应，也未出现4级或5级晚期毒性反应。
在这个未选择的患者队列中，SBRT治疗肝转移耐受性良好，尽管大多数治疗病灶体积较大，但仍能获得良好的局部控制。SBRT后有可能实现长期生存。
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