Originally published as JCO Early Release 10.1200/JCO.2008.20.0600 on March 2 2009

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Phase I Study of Individualized Stereotactic Body Radiotherapy of Liver Metastases

From the Radiation Medicine Program, Departments of Biostatistics and Medical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Corresponding author: Laura Dawson, MD, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Ave, Toronto, Ontario M5G2M9, Canada; e-mail: laura.dawson{at}rmp.uhn.on.ca.

Purpose To report on the outcomes of a phase I study of stereotactic body radiotherapy (SBRT) for treatment of liver metastases.

Patients and Methods Patients with liver metastases that were inoperable or medically unsuitable for resection, and who were not candidates for standard therapies, were eligible for this phase I study of individualized SBRT. Individualized radiation doses were chosen to maintain the same nominal risk of radiation-induced liver disease (RILD) for three estimated risk levels (5%, 10%, and 20%). Additional patients were treated at the maximal study dose (MSD) in an expanded cohort. Median SBRT dose was 41.8 Gy (range, 27.7 to 60 Gy) in six fractions over 2 weeks.

Results Sixty-eight patients with inoperable colorectal (n = 40), breast (n = 12), or other (n = 16) liver metastases were treated. Median tumor volume was 75.2 mL (range, 1.19 to 3,090 mL). The highest RILD risk level investigated was safe, with no dose-limiting toxicity. Two grade 3 liver enzyme changes occurred, but no RILD or other grade 3 to 5 liver toxicity was seen, for a low estimated risk of serious liver toxicity (95% CI, 0 to 5.3%). Six (9%) acute grade 3 toxicities (two gastritis, two nausea, lethargy, and thrombocytopenia) and one (1%) grade 4 toxicity (thrombocytopenia) were seen. The 1-year local control rate was 71% (95 CI, 58% to 85%). The median overall survival was 17.6 months (95% CI, 10.4 to 38.1 months).

Conclusion Individualized six-fraction liver metastases SBRT is safe, with sustained local control observed in the majority of patients.

Supported in part by the Canadian Cancer Society, National Cancer Institute of Canada (Grant No. 018207), Elekta Oncology Systems, and a 2002 American Society of Clinical Oncology career development award (L.A.D.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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