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Stereotactic Single-Dose Radiation Therapy of Liver Tumors: Results of a Phase I/II Trial

From the Divisions of Radiation Oncology, Radiological Diagnostics and Therapy, and Medical Physics, German Cancer Research Center; and Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.

Address reprint requests to K.K. Herfarth, MD, Division of Radiation Oncology, E0500, German Cancer Research Center (dkfz), INF 280, 69120 Heidelberg, Germany; email k.herfarth{at}dkfz.de

PURPOSE: To investigate the feasibility and the clinical response of a stereotactic single-dose radiation treatment for liver tumors.

PATIENTS AND METHODS: Between April 1997 and September 1999, a stereotactic single-dose radiation treatment of 60 liver tumors (four primary tumors, 56 metastases) in 37 patients was performed. Patients were positioned in an individually shaped vacuum pillow. The applied dose was escalated from 14 to 26 Gy (reference point), with the 80% isodose surrounding the planning target volume. Median tumor size was 10 cm³ (range, 1 to 132 cm³). The morbidity, clinical outcome, laboratory findings, and response as seen on computed tomography (CT) scan were evaluated.

RESULTS: Follow-up data could be obtained from 55 treated tumors (35 patients). The median follow-up period was 5.7 months (range, 1.0 to 26.1 months; mean, 9.5 months). The treatment was well tolerated by all patients. There were no major side effects. Fifty-four (98%) of 55 tumors were locally controlled after 6 weeks at the initial follow-up based on the CT findings (22 cases of stable disease, 28 partial responses, and four complete responses). After a dose-escalating and learning phase, the actuarial local tumor control rate was 81% at 18 months after therapy. A total of 12 local failures were observed during follow-up. So far, the longest local tumor control is 26.1 months.

CONCLUSION: Stereotactic single-dose radiation therapy is a feasible method for the treatment of singular inoperable liver metastases with the potential of a high local tumor control rate and low morbidity.

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