title: Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial.
abstract: OBJECTIVE
  To evaluate the feasibility of high-dose stereotactic body radiation therapy (SBRT) in the treatment of unresectable liver metastases.
  
  
  METHODS
  Patients with 1 to 3 liver metastases, with maximum individual tumor diameters less than 6 cm and a Karnofsky Performance Status of at least 70, were enrolled and treated by SBRT on a phase 2 clinical trial. Dose prescription was 75 Gy on 3 consecutive days. SBRT was delivered using the volumetric modulated arc therapy by RapidArc (Varian, Palo Alto, CA) technique. The primary end-point was in-field local control. Secondary end-points were toxicity and survival.
  
  
  RESULTS
  Between February 2010 and September 2011, a total of 61 patients with 76 lesions were treated. Among the patients, 21 (34.3%) had stable extrahepatic disease at study entry. The most frequent primary sites were colorectal (45.9%) and breast (18%). Of the patients, 78.7% had 1 lesion, 18.0% had 2 lesions, and 3.3% had 3 lesions. After a median of 12 months (range, 2-26 months), the in-field local response rate was 94%. The median overall survival rate was 19 months, and actuarial survival at 12 months was 83.5%. None of the patients experienced grade 3 or higher acute toxicity. No radiation-induced liver disease was detected. One patient experienced G3 late toxicity at 6 months, resulting from chest wall pain.
  
  
  CONCLUSIONS
  SBRT for unresectable liver metastases can be considered an effective, safe, and noninvasive therapeutic option, with excellent rates of local control and a low treatment-related toxicity.
authors: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors: Marta
authors: M
authors: Scorsetti
authors: Stefano
authors: S
authors: Arcangeli
authors: Angelo
authors: A
authors: Tozzi
authors: Tiziana
authors: T
authors: Comito
authors: Filippo
authors: F
authors: Alongi
authors: Pierina
authors: P
authors: Navarria
authors: Pietro
authors: P
authors: Mancosu
authors: Giacomo
authors: G
authors: Reggiori
authors: Antonella
authors: A
authors: Fogliata
authors: Guido
authors: G
authors: Torzilli
authors: Stefano
authors: S
authors: Tomatis
authors: Luca
authors: L
authors: Cozzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D047368:Tumor Burden