Alexandria University, Alexandria, Egypt
Eman ElAlfy , Jerome Doyen , Pierre-Yves Bondiau
Background: CyberKnife has shown increasing evidence supporting its use for liver metastases with high rates of local control (LC) and low toxicity. we aim to investigate its safety and efficacy for patients with limited hepatic metastases. Methods: 48 patients (pts) with 63 metastatic liver lesions were treated with Cyberknife between March 2007 and November 2012. Most of pts were aged more than 65 years (ys) (n = 25) and males (n = 25). ECOG Performance status was 2 in 20 pts and 1 in 17 pts. Primary tumors were from GIT (n = 34), breast (6), ovary (2), choroidal melanoma (2), lung (1), kidney (1), thyroid (1) and CUP (1). Number of lesions treated per pt was 1 in 36, 2 in 9 and 3 in 3. GTV volume ranged from 0.81 to 164.07 cm³ (median = 22.53). Median volume of PTV was 23.73 cm³ and mean was 44.11 cm³ (range 2.03 - 215.40). We do not use margin (CTV = GTV). Dose per fraction ranged from 5 Gy to 15 Gy, median total dose was 43.5 Gy (range 25 - 45) in 3 fractions (3-5) and 143 beams prescribed to 80 % isodose line. The delivered median min GTV dose was 39.01 Gy and the prescribed median min PTV dose was 35.55 Gy. Results: Treatment was well tolerated with minimal grade 1 toxicity. 2 acute toxicities as nausea, asthenia and moderate colics. No Grade 3 or higher toxicity. Median follow-up was 11.9 months, overall survival (OS) was 83.6% and 57% at 1 and 2 yrs respectively, disease free survival (DFS) was 69.5% and 46.1% at 1 and 2 yrs and LC was 76.3% and 57.9% at 1 and 2 yrs. OS influenced by; Age < 65 years (P = 0.033), Males (P = 0.050), PTV volume < 50 cm3 (P = 0.002), Coverage > 95% for GTV (P = 0.041). Factors affected DFS were ; Age < 65 years (P = 0.034), Males (P = 0.017), Total dose of 45 Gy (P = 0.001), Dose per fraction equal to 15 Gy (P = 0.001), P.S = 2 (P = 0.024), Max dose > 55 Gy for GTV (P = 0.000), CTV (P = 0.000), PTV (P = 0.000), coverage > 95% for GTV (P = 0.048), CTV (P = 0.031), PTV (P = 0.001), min dose > 35 Gy for GTV (P = 0.032), CTV (p = 0.013), LC affected by; Females (P = 0.013). min dose > 35 Gy for PTV (P = 0.05). Conclusions: Cyberknife is an effective modality with good LC and minimal side effects for limited hepatic metastases. We recommend further studies to define the role of combined modality treatment, clarify treatment parameters and illustrate the related quality of life.
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