Article

Emerging role of radiotherapy in the management of liver metastases.

From the Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
The Cancer Journal (impact factor: 3.26). 16(2):150-5. DOI:10.1097/PPO.0b013e3181d7e8b3 pp.150-5
Source: PubMed

ABSTRACT Improvements with systemic therapy in controlling occult metastatic disease in patients with colorectal cancer and other solid malignancies have raised renewed interest in local therapies that can treat isolated or "oligo" sites of metastatic disease within the liver. Radiotherapy (RT) is a treatment option that can be offered to patients unsuitable for surgery or other ablative therapies. Technological advances in RT planning and delivery have made it possible to administer high doses conformally around focal liver metastases effectively. Methods to facilitate safe delivery of high-dose RT include conformal RT planning, stereotactic body RT, breathing motion management, and image-guided RT. The clinical experience in conformal RT and stereotactic body RT for liver metastases is emerging, with phase I and II trials demonstrating excellent local control and occasional long-term survivors. With appropriate patient selection and sparing of the uninvolved liver, serious toxicity can be avoided. Out-of-field recurrences are common, providing rationale for combining systemic or regional therapies with RT for these patients. Finally, randomized trials of RT for liver metastases are needed to better define the benefits of RT for these patients.

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    Article: Whole-liver radiotherapy for end-stage colorectal cancer patients with massive liver metastases and advanced hepatic dysfunction.
    Seung-Gu Yeo, Dae Yong Kim, Tae Hyun Kim, Sun Young Kim, Yong Sang Hong, Kyung Hae Jung
    [show abstract] [hide abstract]
    ABSTRACT: To investigate whether whole-liver radiotherapy (RT) is beneficial in end-stage colorectal cancer with massive liver metastases and severe hepatic dysfunction. Between June 2004 and July 2008, 10 colorectal cancer patients, who exhibited a replacement of over three quarters of their normal liver by metastatic tumors and were of Child-Pugh class B or C in liver function with progressive disease after undergoing chemotherapy, underwent whole-liver RT. RT was administered using computed tomography-based three-dimensional planning and the median dose was 21 Gy (range, 21-30) in seven fractions. Improvement in liver function tests, defined as a decrease in the levels within 1 month after RT, symptom palliation, toxicity, and overall survival were analyzed retrospectively. Levels of alkaline phosphatase, total bilirubin, aspartate transaminase, and alanine transaminase improved in 8, 6, 9, and all 10 patients, respectively, and the median reduction rates were 42%, 68%, 50%, and 57%, respectively. Serum carcinoembryonic antigen level decreased after RT in three of four assessable patients. For all patients, pain levels decreased and acute toxicity consisted of nausea/vomiting of grade ≤ 2. Further chemotherapy became possible in four of 10 patients. Mean survival after RT was 80 ± 80 days (range, 20-289); mean survival for four patients who received post-RT chemotherapy was 143 ± 100 days (range, 65-289), versus 38 ± 16 days (range, 20-64) for the six patients who did not receive post-RT chemotherapy (p = 0.127). Although limited by small case number, this study demonstrated a possible role of whole-liver RT in improving hepatic dysfunction and delaying mortality from hepatic failure for end-stage colorectal cancer patients with massive liver metastases. Further studies should be followed to confirm these findings.
    Radiation Oncology 10/2010; 5:97. · 2.32 Impact Factor
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Keywords

ablative therapies
 
appropriate patient selection
 
breathing motion management
 
clinical experience
 
conformal RT
 
conformal RT planning
 
doses conformally
 
excellent local control
 
focal liver metastases
 
high-dose RT
 
image-guided RT
 
local therapies
 
occasional long-term survivors
 
occult metastatic disease
 
Out-of-field recurrences
 
regional therapies
 
safe delivery
 
stereotactic body RT
 
Technological advances
 
uninvolved liver