Role of stereotactic body radiation therapy in liver metastasis: A pilot study from tertiary cancer institute in India
Shikhar Kumar1, Rakesh Kapoor2, Arun S Oinam1, Naveen Kalra3, Ajay Duseja4
1 Department of Radiotherapy, PGIMER, Chandigarh, India
2 Department of Radiotherapy, Nehru Hospital, PGIMER, Chandigarh, India
3 Department of Radiodiagnosis, PGIMER, Chandigarh, India
4 Department of Hepatology, PGIMER, Chandigarh, India
Department of Radiotherapy, Ground Floor, B-Block, Nehru Hospital, PGIMER, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Purpose: This trial studies the feasibility and potential utility of stereotactic body radiation therapy in patients with unresectable liver metastasis.
Aims: (1) The aim of this study is to assess the local response of the liver lesions poststereotactic body radiation therapy regarding number and size of lesions and (2) to evaluate the toxicity to organ (s) at risk.
Materials and Methods: A total of 15 patients were enrolled in this study from November 2014 to October 2015. The inclusion criteria for this study were patients having 1–3 liver metastasis from any solid tumor except germ cell tumor or lymphoma with no evidence of progressive disease (PD) outside the liver. A planning four dimensional-computed tomography (CT) scan was taken. Planning target volume was generated by giving margin of 5 mm. Dose prescribed was 36 Gy in 3#. Response was defined by CT abdomen done at 3 and 6 months poststereotactic body radiation therapy as per RECIST guideline (v1.1).
Results: At 3 months poststereotactic body radiation therapy, five patients had partial response, five patients had stable disease, and five patients had PD as per RECIST criteria. Out of 20 assessable lesions, 16 were controlled at 3 months poststereotactic body radiation therapy. The actuarial local control rate was 86% at 3 months and 77% at 6 months poststereotactic body radiation therapy. The median progression free survival was 7 months. Two patients experienced Grade 2 gastric toxicity and one patient experienced Grade 2 small bowel toxicity. No cases of radiation-induced liver disease were observed.
Conclusions: This trial examines the feasibility of stereotactic body radiotherapy to liver metastasis in the Indian scenario. It shows excellent tolerability and is a safe therapeutic option for inoperable patients, showing good local control.