Effect of high-dose stereotactic body radiation therapy on liver function in the treatment of primary and metastatic liver malignancies using the Child-Pugh score classification system

2015 ◽  
Vol 5 (3) ◽  
pp. 176-182 ◽  
Author(s):  
Pawel Dyk ◽  
Ashley Weiner ◽  
Shahed Badiyan ◽  
Robert Myerson ◽  
Parag Parikh ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Liver Function ◽  
Classification System ◽  
Stereotactic Body Radiation Therapy ◽  
High Dose ◽  
Liver Malignancies ◽  
Stereotactic Body Radiation ◽  
Metastatic Liver

Stereotactic Body Radiation Therapy in Multiple Organ Sites

2007 ◽  
Vol 25 (8) ◽  
pp. 947-952 ◽  
Author(s):  
Robert D. Timmerman ◽  
Brian D. Kavanagh ◽  
L. Chinsoo Cho ◽  
Lech Papiez ◽  
Lei Xing
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Advanced Technology ◽  
Dose Fractionation ◽  
Tumor Control ◽  
High Dose ◽  
Stereotactic Body Radiation ◽  
Phase Ii Studies ◽  
Prospective Phase ◽  
Prospective Trials

Introduction Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver a potent ablative dose to deep-seated tumors in the lung, liver, spine, pancreas, kidney, and prostate. Methods SBRT involves constructing very compact high-dose volumes in and about the tumor. Tumor position must be accurately assessed throughout treatment, especially for tumors that move with respiration. Sophisticated image guidance and related treatment delivery technologies have developed to account for such motion and efficiently deliver high daily dose. All this serves to allow the delivery of ablative dose fractionation to the target capable of both disrupting tumor mitosis and cellular function. Results Prospective phase I dose-escalation trials have been carried out to reach potent tumoricidal dose levels capable of eradicating tumors with high likelihood. These studies indicate a clear dose-response relationship for tumor control with escalating dose of SBRT. Prospective phase II studies have been reported from several continents consistently showing very high levels of local tumor control. Although late toxicity requires further careful assessment, acute and subacute toxicities are generally acceptable. Patterns of toxicity, both clinical and radiographic, are distinct from those observed with conventionally fractionated radiotherapy as a result of the unique biologic response to ablative fractionation. Conclusion Prospective trials using SBRT have confirmed the efficacy of treatment in a variety of patient populations. Although mechanisms of ablative-dose injury remain elusive, ongoing prospective trials offer the hope of finding the ideal application for SBRT in the treatment arsenal.

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

2012 ◽  
pp. 261-264 ◽  
Author(s):  
Laura A. Dawson ◽  
Sameh Hashem ◽  
Alexis Bujold
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiation Therapy ◽  
Liver Function ◽  
Randomized Trials ◽  
Stereotactic Body Radiation Therapy ◽  
Great Majority ◽  
High Dose ◽  
Dose Volume ◽  
Systemic Therapies

Overview: Stereotactic body radiotherapy (SBRT), in which highly conformal potent radiation doses are delivered in fewer fractions than traditional radiation therapy (RT), is an increasingly popular treatment for hepatocellular carcinoma (HCC). The great majority of HCCs smaller than 6 cm and with Child-Pugh A liver function are controlled with SBRT with limited toxicity. Long-term local control is reduced in larger tumors, and toxicity is increased in patients with Child-Pugh B or C liver function. SBRT is an effective treatment for tumor vascular thrombi and can lead to sustained vascular recanalization. The first site of recurrence following SBRT is most often within the liver, away from the high dose volume, providing rationale for combining SBRT with regional or systemic therapies. Randomized trials of SBRT are warranted.

Can looking at density differences between liver parenchyma and oligometastatic lesions predict outcomes and toxicities in patients receiving stereotactic body radiation therapy for metastatectomy?

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 479-479
Author(s):  
Will Jin ◽  
Diego Augusto Santos Toesca ◽  
Evan Osmundson ◽  
Jenny Shaffer ◽  
Albert Koong ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Stereotactic Body Radiation Therapy ◽  
Liver Parenchyma ◽  
Liver Lesions ◽  
Radiographic Findings ◽  
Stereotactic Body Radiation ◽  
Increased Risk ◽  
Grade 3 ◽  
Metastatic Liver

479 Background: Stereotactic body radiation therapy (SBRT) has found utility in oligometastatic liver lesions by providing excellent local control in most patients. These tumors are not routinely biopsied to evaluate for histologic grade due to high risk of seeding. Non-invasive pre-treatment radiographic findings may be able to identify a subset of patients at higher risk of local recurrence. Methods: Retrospective review of an IRB-approved database of liver metastases treated with SBRT yielded 55 patients for final analysis. Liver parenchyma and metastatic liver lesions were contoured using MIM version 6.6.5. Receiver Operating Characteristic curves and mean values were used to generate binary cutoffs for toxicities and Kaplan-Meier analysis, respectively. Computer Tomography features, like density, skew, kurtosis, variance, and volume, based on our pre-SBRT planning liver protocol images and their relationship with outcomes and toxicities were examined. Results: Largepre-SBRT density differences between oligometastatic lesions and liver parenchyma, as measured by Hounsfield Units, was associated with a 3.248 increased risk of local failures (p = 0.027) and grade 3 or higher late non-hepatobiliary toxicities (p = 0.032). There were no associations with overall survival. Lesions with large variance in density was associated with grade 3 or higher acute hepatobiliary toxicities (p = 0.043). Conclusions: Density metrics in metastatic liver lesions are readily available in most treatment planning systems and may be a prognostic indicator of tumor aggressiveness. Higher radiation doses may be needed to reduce rates of local recurrence in these patients. Further studies should examine if post-treatment density metrics are dose-dependent and correlate with outcomes.

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