High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases

Esther N.D. Kok*, Edwin P.M. Jansen, Birthe C. Heeres, Niels F.M. Kok, Tomas Janssen, Erik van Werkhoven, Fay R.K. Sanders, Theodore J.M. Ruers, Marlies E. Nowee, Koert F.D. Kuhlmann

*Corresponding author for this work

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Abstract

Introduction: Stereotactic Body Radiation Therapy (SBRT) is a treatment option for patients with liver metastases. This study evaluated the impact of high versus low dose image-guided SBRT of hepatic metastases. Methods and materials: This is a single-center retrospective study of patients with liver metastases treated with SBRT. For analyses, patients were divided into two groups: ≤100 Gy and >100 Gy near-minimum Biological Effective Doses (BED98%). The main outcomes were local control (LC), toxicity and overall survival (OS). Cox regression analyses were performed to determine prognostic variables on LC and OS. Results: Ninety patients with 97 liver metastases (77% colorectal) were included. Median follow-up was 28.6 months. The two-year LC rates in the ≤100 Gy and >100 Gy BED98% group were 60% (CI: 41–80%) and 90% (CI: 80–100%), respectively (p = 0.004). Grade 3 toxicity occurred in 7% vs 2% in the ≤100 Gy and >100 Gy group (p = 0.23). Two-year OS rates in the ≤100 Gy and >100 Gy group were 48% (CI: 32–65%) and 85% (CI: 73–97%), respectively (p = 0.007). In multivariable Cox regression analyses, group dose and tumor volume were significantly correlated with LC (HR: 3.61; p = 0.017 and HR: 1.01; p = 0.005) and OS (HR: 2.38; p = 0.005 and HR: 1.01; p = <0.0001). Conclusion: High dose SBRT provides significantly better local control and overall survival than low dose SBRT without increasing toxicity. When surgical resection is not feasible, high dose SBRT provides an effective and safe treatment for liver metastases.

Original languageEnglish
Pages (from-to)45-50
Number of pages6
JournalClinical and Translational Radiation Oncology
Volume20
Early online date27 Nov 2019
DOIs
Publication statusPublished - Jan 2020

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Radiotherapy
Neoplasm Metastasis
Liver
Survival
Regression Analysis
Tumor Burden
Survival Rate
Retrospective Studies
Therapeutics

Keywords

  • UT-Hybrid-D
  • Liver metastases
  • Local control
  • SBRT
  • Stereotactic Body Radiation Therapy
  • Dose-escalation

Cite this

Kok, E. N. D., Jansen, E. P. M., Heeres, B. C., Kok, N. F. M., Janssen, T., van Werkhoven, E., ... Kuhlmann, K. F. D. (2020). High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases. Clinical and Translational Radiation Oncology, 20, 45-50. https://doi.org/10.1016/j.ctro.2019.11.004
Kok, Esther N.D. ; Jansen, Edwin P.M. ; Heeres, Birthe C. ; Kok, Niels F.M. ; Janssen, Tomas ; van Werkhoven, Erik ; Sanders, Fay R.K. ; Ruers, Theodore J.M. ; Nowee, Marlies E. ; Kuhlmann, Koert F.D. / High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases. In: Clinical and Translational Radiation Oncology. 2020 ; Vol. 20. pp. 45-50.
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title = "High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases",
abstract = "Introduction: Stereotactic Body Radiation Therapy (SBRT) is a treatment option for patients with liver metastases. This study evaluated the impact of high versus low dose image-guided SBRT of hepatic metastases. Methods and materials: This is a single-center retrospective study of patients with liver metastases treated with SBRT. For analyses, patients were divided into two groups: ≤100 Gy and >100 Gy near-minimum Biological Effective Doses (BED98{\%}). The main outcomes were local control (LC), toxicity and overall survival (OS). Cox regression analyses were performed to determine prognostic variables on LC and OS. Results: Ninety patients with 97 liver metastases (77{\%} colorectal) were included. Median follow-up was 28.6 months. The two-year LC rates in the ≤100 Gy and >100 Gy BED98{\%} group were 60{\%} (CI: 41–80{\%}) and 90{\%} (CI: 80–100{\%}), respectively (p = 0.004). Grade 3 toxicity occurred in 7{\%} vs 2{\%} in the ≤100 Gy and >100 Gy group (p = 0.23). Two-year OS rates in the ≤100 Gy and >100 Gy group were 48{\%} (CI: 32–65{\%}) and 85{\%} (CI: 73–97{\%}), respectively (p = 0.007). In multivariable Cox regression analyses, group dose and tumor volume were significantly correlated with LC (HR: 3.61; p = 0.017 and HR: 1.01; p = 0.005) and OS (HR: 2.38; p = 0.005 and HR: 1.01; p = <0.0001). Conclusion: High dose SBRT provides significantly better local control and overall survival than low dose SBRT without increasing toxicity. When surgical resection is not feasible, high dose SBRT provides an effective and safe treatment for liver metastases.",
keywords = "UT-Hybrid-D, Liver metastases, Local control, SBRT, Stereotactic Body Radiation Therapy, Dose-escalation",
author = "Kok, {Esther N.D.} and Jansen, {Edwin P.M.} and Heeres, {Birthe C.} and Kok, {Niels F.M.} and Tomas Janssen and {van Werkhoven}, Erik and Sanders, {Fay R.K.} and Ruers, {Theodore J.M.} and Nowee, {Marlies E.} and Kuhlmann, {Koert F.D.}",
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Kok, END, Jansen, EPM, Heeres, BC, Kok, NFM, Janssen, T, van Werkhoven, E, Sanders, FRK, Ruers, TJM, Nowee, ME & Kuhlmann, KFD 2020, 'High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases', Clinical and Translational Radiation Oncology, vol. 20, pp. 45-50. https://doi.org/10.1016/j.ctro.2019.11.004

High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases. / Kok, Esther N.D.; Jansen, Edwin P.M.; Heeres, Birthe C.; Kok, Niels F.M.; Janssen, Tomas; van Werkhoven, Erik; Sanders, Fay R.K.; Ruers, Theodore J.M.; Nowee, Marlies E.; Kuhlmann, Koert F.D.

In: Clinical and Translational Radiation Oncology, Vol. 20, 01.2020, p. 45-50.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - High versus low dose Stereotactic Body Radiation Therapy for hepatic metastases

AU - Kok, Esther N.D.

AU - Jansen, Edwin P.M.

AU - Heeres, Birthe C.

AU - Kok, Niels F.M.

AU - Janssen, Tomas

AU - van Werkhoven, Erik

AU - Sanders, Fay R.K.

AU - Ruers, Theodore J.M.

AU - Nowee, Marlies E.

AU - Kuhlmann, Koert F.D.

N1 - Elsevier deal

PY - 2020/1

Y1 - 2020/1

N2 - Introduction: Stereotactic Body Radiation Therapy (SBRT) is a treatment option for patients with liver metastases. This study evaluated the impact of high versus low dose image-guided SBRT of hepatic metastases. Methods and materials: This is a single-center retrospective study of patients with liver metastases treated with SBRT. For analyses, patients were divided into two groups: ≤100 Gy and >100 Gy near-minimum Biological Effective Doses (BED98%). The main outcomes were local control (LC), toxicity and overall survival (OS). Cox regression analyses were performed to determine prognostic variables on LC and OS. Results: Ninety patients with 97 liver metastases (77% colorectal) were included. Median follow-up was 28.6 months. The two-year LC rates in the ≤100 Gy and >100 Gy BED98% group were 60% (CI: 41–80%) and 90% (CI: 80–100%), respectively (p = 0.004). Grade 3 toxicity occurred in 7% vs 2% in the ≤100 Gy and >100 Gy group (p = 0.23). Two-year OS rates in the ≤100 Gy and >100 Gy group were 48% (CI: 32–65%) and 85% (CI: 73–97%), respectively (p = 0.007). In multivariable Cox regression analyses, group dose and tumor volume were significantly correlated with LC (HR: 3.61; p = 0.017 and HR: 1.01; p = 0.005) and OS (HR: 2.38; p = 0.005 and HR: 1.01; p = <0.0001). Conclusion: High dose SBRT provides significantly better local control and overall survival than low dose SBRT without increasing toxicity. When surgical resection is not feasible, high dose SBRT provides an effective and safe treatment for liver metastases.

AB - Introduction: Stereotactic Body Radiation Therapy (SBRT) is a treatment option for patients with liver metastases. This study evaluated the impact of high versus low dose image-guided SBRT of hepatic metastases. Methods and materials: This is a single-center retrospective study of patients with liver metastases treated with SBRT. For analyses, patients were divided into two groups: ≤100 Gy and >100 Gy near-minimum Biological Effective Doses (BED98%). The main outcomes were local control (LC), toxicity and overall survival (OS). Cox regression analyses were performed to determine prognostic variables on LC and OS. Results: Ninety patients with 97 liver metastases (77% colorectal) were included. Median follow-up was 28.6 months. The two-year LC rates in the ≤100 Gy and >100 Gy BED98% group were 60% (CI: 41–80%) and 90% (CI: 80–100%), respectively (p = 0.004). Grade 3 toxicity occurred in 7% vs 2% in the ≤100 Gy and >100 Gy group (p = 0.23). Two-year OS rates in the ≤100 Gy and >100 Gy group were 48% (CI: 32–65%) and 85% (CI: 73–97%), respectively (p = 0.007). In multivariable Cox regression analyses, group dose and tumor volume were significantly correlated with LC (HR: 3.61; p = 0.017 and HR: 1.01; p = 0.005) and OS (HR: 2.38; p = 0.005 and HR: 1.01; p = <0.0001). Conclusion: High dose SBRT provides significantly better local control and overall survival than low dose SBRT without increasing toxicity. When surgical resection is not feasible, high dose SBRT provides an effective and safe treatment for liver metastases.

KW - UT-Hybrid-D

KW - Liver metastases

KW - Local control

KW - SBRT

KW - Stereotactic Body Radiation Therapy

KW - Dose-escalation

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U2 - 10.1016/j.ctro.2019.11.004

DO - 10.1016/j.ctro.2019.11.004

M3 - Article

AN - SCOPUS:85075884133

VL - 20

SP - 45

EP - 50

JO - Clinical and Translational Radiation Oncology

JF - Clinical and Translational Radiation Oncology

SN - 2405-6308

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