Radiosurgery for recurring liver metastases after hepatectomy.
OBJECTIVE
Most resected liver metastases from colorectal cancer recur. A minority of liver recurrences have been re-resected, but most re-resections fail and they decrease the postoperative performance status for a longer time than the initial resections, so that less demanding potentially curative treatments need evaluation.


METHODS
Four out of 5 liver-only recurrences after 18 consecutive liver resections were limited and suitable for radiosurgery. The patients were fixed in a frame and stereotactic irradiation with 20 Gy twice or 15 Gy three times was delivered to the tumors.


RESULTS
Limited side effects were seen, without medical need for hospital admission. Thirteen--101 months later, all treated tumors were locally controlled with complete radiologic remission of two of them. Only one patient recurred in the liver, with bilobar lesions preceded by extrahepatic spread. Neither recurrence would have been prevented by a rehepatectomy instead of irradiation. One patient died later tumor-free from stroke, two died from generalized tumors, and one remains in remission 101 months after radiosurgery.


CONCLUSIONS
Radiosurgery of liver tumors merits further study, and may offer a less demanding alternative to resection for selected liver tumors with the prospect of long-term survival.
Department of Oncology, Radiumhemmet, Karolinska Hospital, SE 171 76 Stockholm, Sweden. peter.gunven@ks.se
Peter
P
Gunvén
Henric
H
Blomgren
Ingmar
I
Lax
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D016634:Radiosurgery; D011879:Radiotherapy Dosage