Stereotactic body radiation therapy using the CyberKnife® system for patients with liver metastases

Zhi-Yong Yuan,* Mao-Bin Meng,* Chun-Lei Liu,* Huan-Huan Wang,* Chao Jiang, Yong-Chun Song, Hong-Qing Zhuang, Dong Yang, Jing-Sheng Wang, Wang Wei, Feng-Tong Li, Lu-Jun Zhao, Ping Wang Department of Radiation Oncology, CyberKnife® Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, People’s Republic of China*These authors contributed equally to this workAbstract: The aim of this study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) in the treatment of patients with liver metastases. Between August 2006 and July 2011, patients with 1–4 liver metastases were enrolled and treated with SBRT using the CyberKnife® system at Tianjin Medical University Cancer Institute and Hospital. The metastases were from different primary tumors, with a maximum tumor diameter of less than 6 cm. The primary endpoint was local control. Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events. Fifty-seven patients with 80 lesions were treated with SBRT. The 1-year and 2-year local control rates were 94.4% and 89.7%, respectively. The difference in local control between patients who received adjuvant treatment before SBRT and those who did not reached statistical significance (P=0.049). The median overall survival for the entire cohort was 37.5 months. According to the primary tumor sites, the median overall survival was not reached. The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001). Grade 1–2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed. With excellent local control in the absence of severe toxicity, SBRT provides an alternative for patients with 1–4 liver metastases who cannot undergo surgery or other treatments.Keywords: liver metastasis, stereotactic body radiotherapy, local contro