title: Stereotactic Body Radiotherapy for Inoperable Liver Tumors: Results of a Single Institutional Experience.
abstract: OBJECTIVE
  Stereotactic body radiation therapy (SBRT) is an emerging treatment option for liver tumors unsuitable for ablation or surgery. We report our experience with SBRT in the treatment of liver tumors.
  
  
  METHODS
  Patients with primary or secondary liver cancer were identified in our local SBRT database. Patients were included irrespective of prior liver-directed therapies. The primary endpoint of our review was in-field local control (LC). Secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity.
  
  
  RESULTS
  From 2009 to 2015, a total of 71 liver lesions in 68 patients were treated with SBRT (three patients had two liver lesions treated). The median age was 71 years (27-89 years). Hepatocellular carcinoma (HCC) was the diagnosis in 23 patients (34%), with the grade of Child-Pugh A (52%), B (39%), or C (nine percent) cirrhosis. Six patients (nine percent) had intrahepatic cholangiocarcinoma (IHC). The remaining 39 patients (57%) had metastatic liver lesions. Colorectal adenocarcinoma was the most common primary tumor type (81%). The median size for HCC, IHC, and metastatic lesions was 5 cm (2-9 cm), 3.6 cm (2-4.9 cm), and 4 cm (1-8 cm), respectively. The median prescribed dose was 45 Gy (16-50 Gy). Median follow-up was 11.5 months (1-45 months). Actuarial one-year in-field LC for HCC and metastatic lesions was 85% and 64% respectively (p= 0.66). At one year, the actuarial rate of new liver lesions was 40% and 26%, respectively, (p=0.58) for HCC and metastases. Only six patients with IHC were treated with SBRT in this study - in these patients, one-year LC was 78% with new liver lesions in 53%. The SBRT treatments were well tolerated. The side effects included common criteria for adverse events (CTCAE) v4 grade 1 acute gastrointestinal toxicity in three patients, grade 3 nausea in one patient, and grade 3 acute dermatitis in another patient. Two patients had grade 5 toxicity. Radiation pneumonitis was observed in one patient two months post-SBRT treatment, and another patient was suspected to have had radio-induced liver disease (RILD) two months after SBRT. No late toxicity was seen.
  
  
  CONCLUSIONS
  SBRT is a well-tolerated and effective alternative treatment option for selected patients with primary and metastatic liver tumors.
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM) ; King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
authors.forename: Hussam
authors.initials: H
authors.lastname: Hijazi
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Campeau
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Center ; Department of Radiology, Radiation Oncology and Nuclear Medicine, University of Montreal ; Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM) ; Department of Oncology, Division of Radiation Oncology, McGill University Health Center.
authors.forename: David
authors.initials: D
authors.lastname: Roberge
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: David
authors.initials: D
authors.lastname: Donath
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Real
authors.initials: R
authors.lastname: Lapointe
authors.affiliation: Unit of Hepato-Biliary and Pancreatic Surgery, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Franck
authors.initials: F
authors.lastname: Vandenbroucke-Menu
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Daniel
authors.initials: D
authors.lastname: Taussky
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Karim
authors.initials: K
authors.lastname: Boudam
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, Hôpital Maisonneuve-Rosemont.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont.
authors.forename: Alexis
authors.initials: A
authors.lastname: Bujold
authors.affiliation: Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM).
authors.forename: Guila
authors.initials: G
authors.lastname: Delouya
keywords: hcc; liver cancer; metastatic liver tumors; sbrt; stereotactic body radiotherapy