Long-term Survival in Patients Treated with a Robotic Radiosurgical Device for Liver Metastases
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Purpose The treatment of liver metastases with local procedures is a fast progressing field. For the most, long-term survival data is missing raising questions with regard to the efficacy of such modalities when compared to surgical resection. Radiosurgery using the CyberKnife device enables the treatment of liver lesions with a single-session approach. Here we present longterm survival data to explore the curative potential of this strategy. Materials and Methods Patients with oligo-metastatic disease limited to the liver have been treated with single-session or hypo-fractioned radiosurgery in curative intent and prospectively followed until death. Follow-up (FU) was performed using magnetic resonance imaging (MRI) 2 months after radiation and at 3-month intervals for the first 2 years. After that annual computed tomography or MRI scans were performed until 5 years post-treatment. Local recurrence in the radiated volume and recurrence outside the treated volume were used to define local and distant progression. Survival times were censored at the time of the last FU. Results One hundred twenty-six patients treated between 2005 and 2015 with 194 lesions were included into this study. Median FU was 30.0 months. According to Response Evaluation Criteria in Solid Tumors, 55.2% had a complete remission and 11.3% a partial remission. Seventy-two point two percent recurred outside the radiated lesion and median overall survival was 35.2 months with a 3-year survival rate of 47.7%. Conclusion This is currently the largest cohort of stereotactic body radiation therapy treated liver lesions with a median long-term follow of 30 months. Robotic radiosurgery using a single session approach has a high efficacy to control the radiated lesion with the potential to cure patients.
Abstract
Purpose The treatment of liver metastases with local procedures is a fast progressing field. For the most, long-term survival data is missing raising questions with regard to the efficacy of such modalities when compared to surgical resection. Radiosurgery using the CyberKnife device enables the treatment of liver lesions with a single-session approach. Here we present longterm survival data to explore the curative potential of this strategy. Materials and Methods Patients with oligo-metastatic disease limited to the liver have been treated with single-session or hypo-fractioned radiosurgery in curative intent and prospectively followed until death. Follow-up (FU) was performed using magnetic resonance imaging (MRI) 2 months after radiation and at 3-month intervals for the first 2 years. After that annual computed tomography or MRI scans were performed until 5 years post-treatment. Local recurrence in the radiated volume and recurrence outside the treated volume were used to define local and distant progression. Survival times were censored at the time of the last FU. Results One hundred twenty-six patients treated between 2005 and 2015 with 194 lesions were included into this study. Median FU was 30.0 months. According to Response Evaluation Criteria in Solid Tumors, 55.2% had a complete remission and 11.3% a partial remission. Seventy-two point two percent recurred outside the radiated lesion and median overall survival was 35.2 months with a 3-year survival rate of 47.7%. Conclusion This is currently the largest cohort of stereotactic body radiation therapy treated liver lesions with a median long-term follow of 30 months. Robotic radiosurgery using a single session approach has a high efficacy to control the radiated lesion with the potential to cure patients.
참고문헌 (28)
- Kopetz S, "Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy", J Clin Oncol, 27, pp.3677~3683 (2009)
- Van Cutsem E, "ESMO consensus guidelines for the management of patients with metastatic colorectal cancer", Ann Oncol, 27, pp.1386~1422 (2016)
- Abdalla EK, "Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection", ablation for colorectal liver metastases, 2004, pp.239, 818~825
- Chan KM, "Prognostic significance of the number of tumors and aggressive surgical approach in colorectal cancer hepatic metastasis", World J Surg Oncol, 12, pp.155~ (2014)
- 박민수, "Histopathologic factors affecting tumor recurrence after hepatic resection in colorectal liver metastases", Annals of Surgical Treatment and Research, 87(1), pp.14~21 (2014), 대한외과학회
- van Amerongen MJ, "Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases : a meta-analysis", HPB(Oxford), 19, pp.749~756 (2017)
- 박은규, "A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma", Annals of Surgical Treatment and Research, 87(2), pp.72~80 (2014), 대한외과학회
- Santambrogio R, "Comparison of laparoscopic microwave to radiofrequency ablation of small hepatocellular carcinoma (≤ 3 cm)", Ann Surg Oncol, 24, pp.257~263 (2017)
- Rusthoven KE, "Multi-institutional phase I", II trial of stereotactic body radiation therapy for liver metastases, 2009, pp.27, 1572~1578
- Dawood O, "Stereotactic body radiation therapy for liver metastases", Eur J Cancer, 45, pp.2947~2959 (2009)
- Pech M, "Radiotherapy of liver metastases : comparison of target volumes and dose-volume histograms employing CT-or MRI-based treatment planning", Strahlenther Onkol, 184, pp.256~261 (2008)
- Stintzing S, "Radiosurgery of liver tumors : value of robotic radiosurgical device to treat liver tumors", Ann Surg Oncol, 17, pp.2877~2883 (2010)
- Benedict SH, "Stereotactic body radiation therapy : the report of AAPM Task Group 101", Med Phys, 37, pp.4078~4101 (2010)
- Schweikard A, "Respiration tracking in radiosurgery", Med Phys, 31, pp.2738~2741 (2004)
- Dawson LA, "Analysis of radiation-induced liver disease using the Lyman NTCP model", Int J Radiat Oncol Biol Phys, 53, pp.810~821 (2002)
- Kirkpatrick JP, "Point", Counterpoint. The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery, 2009, pp.36, 3381~3384
- Herfarth KK, "Stereotactic single-dose radiation therapy of liver tumors : results of a phase I", II trial, 2001, pp.19, 164~170
- Herfarth KK, "Assessment of focal liver reaction by multiphasic CT after stereotactic single-dose radiotherapy of liver tumors", Int J Radiat Oncol Biol Phys, 57, pp.444~451 (2003)
- Wagman R, "Respiratory gating for liver tumors : use in dose escalation", Int J Radiat Oncol Biol Phys, 55, pp.659~668 (2003)
- Goodman KA, "Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies", Int J Radiat Oncol Biol Phys, 78, pp.486~493 (2010)
- Nordlinger B, "Surgical resection of colorectal carcinoma metastases to the liver: a prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie", Cancer, 77, pp.1254~1262 (1996)
- Fong Y, "Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer : analysis of 1001 consecutive cases", Ann Surg, 230, pp.309~318 (1999)
- Silberhumer GR, "Long-term oncologic outcomes for simultaneous resection of synchronous metastatic liver and primary colorectal cancer", Surgery, 160, pp.67~73 (2016)
- Homayounfar K, "Metastatic recurrence after complete resection of colorectal liver metastases : impact of surgery and chemotherapy on survival", Int J Colorectal Dis, 28, pp.1009~1017 (2013)
- Leal JN, "Time-to-surgery and survival outcomes in resectable colorectal liver metastases : a multi-institutional evaluation", J Am Coll Surg, 222, pp.766~779 (2016)
- Veltri A, "Radiofrequency ablation of colorectal liver metastases : small size favorably predicts technique effectiveness and survival", Cardiovasc Intervent Radiol, 31, pp.948~956 (2008)
- Berber E, "Local recurrence after laparoscopic radiofrequency ablation of liver tumors : an analysis of 1032tumors", Ann Surg Oncol, 15, pp.2757~2764 (2008)
- Lencioni R, "Image-guided ablation of malignant liver tumors: recommendations for clinical validation of novel thermal and nonthermal technologie. A Western Perspective", Liver Cancer, 4, pp.208~214 (2015)