Liver SBRT with active motion-compensation results in excellent local control for liver oligometastases: An outcome analysis of a pooled multi-platform patient cohort

• Published in: Radiotherapy and oncology Vol. 158; pp. 230 - 236
• Main Authors: Stera, Susanne, Miebach, Georgia, Buergy, Daniel, Dreher, Constantin, Lohr, Frank, Wurster, Stefan, Rödel, Claus, Marcella, Szücs, Krug, David, Frank A., Giordano, Ehmann, Michael, Fleckenstein, Jens, Blanck, Oliver, Boda-Heggemann, Judit
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2021
• Subjects: Active motion management; CyberKnife; Deep inspiration breath hold; Liver SBRT; Robotic tracking; Liver SBRT; Deep inspiration breath hold; CyberKnife; Active motion management; Robotic tracking
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2021.02.036

•Liver SBRT.•Active motion management.•Deep inspiration breath hold.•Robotic tracking. Local treatment of metastases in combination with systemic therapy can prolong survival of oligo-metastasized patients. To fully exploit this potential, safe and effective treatments are needed to ensure long-term metastases control. Stereotactic body radiotherapy (SBRT) is one means, however, for moving liver tumors correct delivery of high doses is challenging. After validating equal in-vivo treatment accuracy, we analyzed a pooled multi-platform liver-SBRT-database for clinical outcome. Local control (LC), progression-free interval (PFI), overall survival (OS), predictive factors and toxicity was evaluated in 135 patients with 227 metastases treated by gantry-based SBRT (deep-inspiratory breath-hold-gating; n = 71) and robotic-based SBRT (fiducial-tracking, n = 156) with mean gross tumor volume biological effective dose (GTV-BEDα/β=10Gy) of 146.6 Gy10. One-, and five-year LC was 90% and 68.7%, respectively. On multivariate analysis, LC was significantly predicted by colorectal histology (p = 0.006). Median OS was 20 months with one- and two-year OS of 67% and 37%. On multivariate analysis, ECOG-status (p = 0.003), simultaneous chemotherapy (p = 0.003), time from metastasis detection to SBRT-treatment (≥2months; p = 0.021) and LC of the treated metastases (≥12 months, p < 0.009) were significant predictors for OS. One- and two-year PFI were 30.5% and 14%. Acute toxicity was mild and rare (14.4% grade I, 2.3% grade II, 0.6% grade III). Chronic °III/IV toxicities occurred in 1.1%. Patient selection, time to treatment and sufficient doses are essential to achieve optimal outcome for SBRT with active motion compensation. Local control appears favorable compared to historical control. Long-term LC of the treated lesions was associated with longer overall survival.