title: Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors.
abstract: OBJECTIVE
  We report single center experience on the outcome and toxicity of SBRT alone or in combination with surgery for inoperable primary and metastatic liver tumors between 2007 and 2014.
  
  
  METHODS
  Patients with 1-4 hepatic lesions and tumor diameter ≤9 cm received SBRT at 46.8Gy ± 3.7 in 4-6 fractions. The primary end point was local control with at least 6 months of radiographic followup, and secondary end points were toxicity and survival.
  
  
  RESULTS
  Eighty-seven assessable patients (114 lesions) completed liver SBRT for hepatoma (39) or isolated metastases (48) with a median followup of 20.3 months (range 1.9-64.1). Fourteen patients underwent liver transplant with SBRT as a bridging treatment or for tumor downsizing. Eight patients completed hepatic resections in combination with planned SBRT for unresectable tumors. Two-year local control was 96% for hepatoma and 93.8% for metastases; it was 100% for lesions ≤4 cm. Two-year overall survival was 82.3% (hepatoma) and 64.3% (metastases). No incidence of grade >2 treatment toxicity was observed.
  
  
  CONCLUSIONS
  In this retrospective analysis we demonstrate that liver SBRT alone or in combination with surgery is safe and effective for the treatment of isolated inoperable hepatic malignancies and provides excellent local control rates.
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA. Electronic address: akiriche@wpahs.org.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kirichenko
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gayou
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Parda
authors.affiliation: Department of Oncology, Division of Radiation Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kudithipudi
authors.affiliation: Department of General Surgery, Division of Abdominal Transplant, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Kusum
authors.initials: K
authors.lastname: Tom
authors.affiliation: Department of General Surgery, Division of Abdominal Transplant, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Akhtar
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of General Surgery, Division of Abdominal Transplant, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Abrams
authors.affiliation: Department of General Surgery, Division of Abdominal Transplant, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Szramowski
authors.affiliation: Division of Gastroenterology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Oliva
authors.affiliation: Division of Medical Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Dulabh
authors.initials: D
authors.lastname: Monga
authors.affiliation: Division of Medical Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Moses
authors.initials: M
authors.lastname: Raj
authors.affiliation: Department of General Surgery, Division of Abdominal Transplant, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
authors.forename: Ngoc
authors.initials: N
authors.lastname: Thai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D010414:Pennsylvania; D016634:Radiosurgery / Q000009:adverse effects / Q000401:mortality; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden