Liver SBRT with active motion-compensation results in excellent local control for liver oligometastases: An outcome analysis of a pooled multi-platform patient cohort. (May 2021)

• Record Type: Journal Article
• Authors: Stera, Susanne; Miebach, Georgia; Buergy, Daniel; Dreher, Constantin; Lohr, Frank; Wurster, Stefan; Rödel, Claus; Marcella, Szücs; Krug, David; Frank A., Giordano; Ehmann, Michael; Fleckenstein, Jens; Blanck, Oliver; Boda-Heggemann, Judit
• Is Part Of: Radiotherapy and oncology. Volume 158(2021)
• Page Start: 230
• Page End: 236
• Publication Date: 2021-05
• Subjects: Liver SBRT -- Active motion management -- Deep inspiration breath hold -- Robotic tracking -- CyberKnife; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.02.036
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Liver SBRT. Active motion management. Deep inspiration breath hold. Robotic tracking. Abstract: 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.