title: Image-guided radiation therapy for liver tumors: gastrointestinal histology matters.
abstract: OBJECTIVE
  To describe the safety and efficacy of single-fraction and hypofractionated image-guided radiotherapy techniques for the treatment of large liver tumors.
  
  
  METHODS
  Forty-six patients, with 50 tumors (10 primary liver tumors, 40 liver metastases) from March 2004 to March 2011 were reviewed. The maximal tumor diameter ranged from 1.2 to 11.3 cm (median, 4.2 cm). Eighty-seven percent of patients received prior systemic chemotherapy. Fifty-nine percent had prior invasive local therapy including surgery, ablation, or embolization. Twenty-five lesions were treated with hypofractionated therapy (24 to 30 Gy in 3 to 5 fractions), whereas 19 received a single fraction (18 or 24 Gy). Local control (LC) was calculated using competing risk analysis. Overall survival was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  Median follow-up for all patients was 29.8 months (range, 3 to 46 mo). The median survival was 15.4 months. The 1- and 2-year LC rates were 78% and 75%, respectively. Dose and tumor size had no significant effect on tumor progression. The local progression at 1 and 2 years was 29% and 32% for gastrointestinal (GI) histologies versus 0% for non-GI histologies (P=0.02). Tumor volumes larger than 112 cm correlated with decreased survival (P=0.05). Three patients developed late grade 3 GI stricture or ulceration.
  
  
  CONCLUSIONS
  Image-guided radiotherapy for liver tumors achieves good rates of LC with minimal toxicity at 1 and 2 years even in patients with large or recurrent disease that has been heavily pretreated. GI histology demonstrated decreased LC rates. Further management strategies should be considered in these patients.
authors: Departments of *Radiation Oncology ‡Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY †Department of Radiation Oncology, University of Wisconsin, Madison, WI.
authors: Evangelia
authors: E
authors: Katsoulakis
authors: Nadeem
authors: N
authors: Riaz
authors: Donald M
authors: DM
authors: Cannon
authors: Karyn
authors: K
authors: Goodman
authors: Daniel E
authors: DE
authors: Spratt
authors: Michael
authors: M
authors: Lovelock
authors: Yoshiya
authors: Y
authors: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D001653:Bile Ducts, Intrahepatic; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D061089:Radiotherapy, Image-Guided; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult