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Abstract

PURPOSE:
To evaluate the effective dose and patterns of recurrence after stereotactic body radiation therapy (SBRT) for hepatic metastases that arise from colorectal cancer.

METHODS AND MATERIALS:
A cohort of 70 patients with 103 colorectal liver metastases were treated with SBRT at a single institution. The prescribed doses were 45 to 60 Gy in 3 to 4 fractions, but these were modified according to the tolerance of the adjacent normal tissue. To allow for dose comparisons, a biological equivalent dose was calculated.

RESULTS:
The median follow-up period was 34.2 months (range, 5.3-121.8 months). The 2-year overall survival and progression-free survival rates were 75% and 35%, respectively. In subgroups, the 2-year local control rates for biological equivalent dose ≤80 Gy (group 1), 100 to 112 Gy (group 2), and ≥132 Gy (group 3) were 52%, 83%, and 89%, respectively. Cox proportional hazards model revealed a significant difference between groups (hazard ratio 0.44, P=.03 for group 2; hazard ratio 0.17, P=.17 for group 3; P=.01 for total). The major pattern of failure was a new liver metastasis out of the SBRT field. There was no grade ≥3 toxicity.

CONCLUSIONS:
Stereotactic body radiation therapy of liver metastases derived from colorectal cancer offers a locally effective treatment without significant complications. Longer local control can be expected if higher doses are used. Further studies will be needed to compare the efficacies of SBRT with those of surgical resection or radiofrequency ablation.

Author information

Joo JH1, Park JH1, Kim JC2, Yu CS2, Lim SB2, Park IJ2, Kim TW3, Hong YS3, Kim KP3, Yoon SM1, Park J4, Kim JH5.
1
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
2
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
3
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
4
Dangjin Public Health Center, Dangjin-si, Chungcheongnam-do, South Korea.
5
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: jhkim2@amc.seoul.kr.