Robotic radiosurgery treatment in liver tumours: early experience from an indian centre

Dutta, D.; S. H.; Balaji, S.; Jayaraj, G.; Kurup, P.; Murli, V.
March 2013
Journal of Radiosurgery & SBRT;2013 Supplement 2.1, Vol. 2, p112
Academic Journal
Purpose: We report initial experience with SBRT in patients hepatocellular carcinoma (HCC), liver metastasis (LM) and Klastkin tumour (KT). Methods: Seventeen consecutive patients (mean age 57.5 years, range 35-81 yrs; 82% male) treated with fiducial based robotic radiosurgery. Nine patients had HCC (n=9) and four each had LM (n=4) and KT (n=4). 11/17 patient (70%) were with Child Pugh A/B, 8/9 with HCC had infective hepatitis (4 each with hepatitis B & C), 5/17 (29%) had diffuse cirrhosis, 70%(12/17) had single lesion in liver and target volume <10cc in 3 patient (17%), 11-90cc in 8 (47%) and >90 cc in 6 (35%) patients respectively. 13/17 (75%) patients had prior treatment [chemotherapy 8/13 (61%), TACE 5/13 (39%)] and treated with SBRT on progression. All patients were treated with 3 fractions (21-45Gy/3#; mean dose 33Gy, prescription isodose 84%, target coverage 94%); fiducial tracking based CyberKnife. Mean CI, nCI, HI was 1.13, 1.28 and 1.19 respectively. Mean liver dose was 4.7 Gy, 800cc liver dose 8.2 Gy; 2% small intestine dose 10.6 Gy. Mean nodes, beamlets, monitor units and treatment time 69, 174, 46919 and 60.4 min respectively. Results: At mean follow up of 11.3 months (range 1.9-26.5), 12/17 (70%) patients expired and 5/17 (30%) alive (3 patient with controlled primary, one each with local progression and metastasis). Median overall survival (OS) in HCC patients was 11.9 months (2.1-26.5 months), MT 8.3 months (1.9-13.3 months) and KT was 12.8 months (7.4-25 months) respectively. 5/17 (30%) patients had grade I-II GI toxicities, no grade III-IV toxicities were observed and only one patient (12%) had anicteric ascites with high serum alkaline phosphatase two months after CK and recovered with supportive care. Median OS (month) were significantly influenced by factors such as performance status (KPS 70-80 vs 90-100: 8.3 vs 15.4; p=0.034), Child Pugh (CP A/B vs C: 13.3 vs 4.9; p=0.039), cirrhosis (only fatty liver vs diffuse cirrhosis: 13.3 vs 9.4; p=0.005), prior treatment (no Rx vs prior Rx: 16.6 vs 8.3; p=0.006), dose (<39Gy vs >39Gy: 9.5 vs 15.4; p=0.02) and target volume (<10cc vs >90 cc: 15.7 vs 7.7; p=0.011) respectively. There was no fiducial related toxicity or migration. Conclusion. SBRT is safe and effective local treatment modality in selected patients with liver malignancies with minimal adverse events. Factors such as performace status, Child Pugh classification, cirrhosis status, prior treatment, RT dose and target volume significantly influence survival function. Disclosure: No significant relationships.


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