Stereotactic body radiotherapy (SBRT) of liver metastases

Study PI:

PD Dr. med. Nicolaus Andratschke
University Hospital Zurich

Study design:

● multi-center, international retrospective study

Study objective:

● To perform a patterns-of-care and patterns-of-outcome analysis of SBRT for liver metastases in Germany, Austria and Switzerland
● To evaluate patient and treatment factor influencing outcome in SBRT for liver metastases

Project status:

  • Data collection completed
  • 3 full manuscripts published
  • Project closed

Major findings and results:

Klement RJ, Abbasi-Senger N, Adebahr S, et al (2019) The impact of local control on overall survival after stereotactic body radiotherapy for liver and lung metastases from colorectal cancer: a combined analysis of 388 patients with 500 metastases. BMC Cancer 19:173.

  • 388 patients with 500 metastatic lesions (lung and liver) of colorectal cancer were analysed retrospectively in order to assess the impact of local control on overall survival
  • The assessment was performed using an illness-death model framework
  • Median follow-up was 12.1 months and 17.8 months for local control and overall survival, respectively
  • 31.3% of liver metastases relapsed compared to 10% of lung metastases
  • Local control was associated with longer overall survival for patients as the median survival was 25.4 months and 30.6 months for patients with or without local failure. This association is meaningful for patients living ≥ 12 months after SBRT

Andratschke N, Alheid H, Allgäuer M, et al (2018) The SBRT database initiative of the German Society for Radiation Oncology (DEGRO): patterns of care and outcome analysis of stereotactic body radiotherapy (SBRT) for liver oligometastases in 474 patients with 623 metastases. BMC Cancer 18:283.

  • 474 patients with 623 liver oligometastases treated with SBRT were analyzed retrospectively for patterns of care of SBRT, overall survival, and local metastasis control
  • Predominant histologies: colorectal cancer (300 lesions), breast cancer (81 lesions)
  • Set-up modalities: stereotactic coordinates (55%), CBCT guidance (28%), robotic tracking (17%)
  • SBRT prescription was variable: median fraction number = 1 (range 1-13), median dose per fraction = 18.5 Gy (range 3 - 37.5 Gy) , but biologically equivalent dose still consistently high
  • Median follow-up 15 months, median OS 24 months, 1-y-local treated metastasis control rate 77%, 2-y-local treated metastasis control rate 64%
  • Treated metastasis control was better with increased biologically equivalent dose (>150 Gy EQD2Gy), motion management methods, colorectal or breast histology

Klement R, Guckenberger M, Alheid H et al. Stereotactic body radiotherapy (SBRT) for oligometastatic liver disease – influence of pre-treatment chemotherapy and histology on local tumor control.

  • 452 SBRT treatments in 363 patients were analysed after collection of patient, tumor and treatment from 17 centers between 1997 and 2015 in a multi-center DEGRO AG database.
  • After adjusting for histology, a strong dose-response relationship was observed and BEDmax was the strongest predictor of TCP.
  • Breast cancer metastases were significantly more responsive to SBRT compared to other histologies with 90% TCP at 2 years with BEDmax of 178±65 Gy10 or 94±55 Gy10 with and without prior chemotherapy, respectively.
  • Chemotherapy prior to SBRT predicted for significantly lower TCP. The model predicted a BED of 208±76 Gy10 necessary for 90% TCP at 2 years with no prior chemotherapy, but 292±109 Gy10 when chemotherapy had been given.