Radiotherapeutic treatment options for oligotopic malignant liver lesions.
Brachytherapy
Colorectal cancer
Liver metastasis
Oligometastasis
Radiation therapy
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
16 Mar 2021
16 Mar 2021
Historique:
received:
01
02
2021
accepted:
02
03
2021
entrez:
17
3
2021
pubmed:
18
3
2021
medline:
9
11
2021
Statut:
epublish
Résumé
Several radiotherapeutic approaches for patients with oligotopic malignant liver lesions unfit for surgical resection exist. The most advanced competitive techniques are high-dose-rate (HDR) brachytherapy, Cyberknife, volume-modulated-arc therapy (VMAT) and Tomotherapy. We evaluated the optimal technique by a planning study for a single ablative dose with different lesion sizes. We compared dose distributions of HDR-brachytherapy with stereotactic ablative radiotherapy using the Cyberknife, VMAT or Tomotherapy. Tumor-control-probabilities (TCP), normal-tissue-complication-probabilities (NTCP) were determined in a theoretical framework applying a single dose of 20 Gy (demanding 95% coverage) for intrahepatic lesions of 1-5 cm in size. We evaluated therapeutic ratios by TCP (mean dose in the lesion) relative to high-dose (conformality) or low-dose liver exposition in dependency on the lesion size for each technique. In addition, we considered treatment times and accuracy (clinical target volume vs planning target volume). HDR-brachtherapy has the highest therapeutic ratios with respect to high-dose as well as low-dose liver exposition even for extended lesions, and the Cyberknife being suited second best. However, for lesions ≥ 3 cm diameter the therapeutic ratios of all ablative techniques are increasingly converging, and better tolerance and shorter treatment times of noninvasive external techniques become more important. On the other hand, mean tumor doses of HDR-brachytherapy of near 60 Gy are unattainable by the other techniques gaining only 22-34 Gy, and the conformality of HDR-brachytherapy is still rather good for lesions ≥ 3 cm diameter. HDR-brachytherapy is by far the most effective technique to treat intrahepatic lesions by a single fraction, but sparing of the surroundings declines with increasing lesion size and approaches the benchmarks of external beam radiosurgery techniques. External beam radiotherapy has the advantage to use suitable fractionation schedules.
Sections du résumé
BACKGROUND
BACKGROUND
Several radiotherapeutic approaches for patients with oligotopic malignant liver lesions unfit for surgical resection exist. The most advanced competitive techniques are high-dose-rate (HDR) brachytherapy, Cyberknife, volume-modulated-arc therapy (VMAT) and Tomotherapy. We evaluated the optimal technique by a planning study for a single ablative dose with different lesion sizes.
METHODS
METHODS
We compared dose distributions of HDR-brachytherapy with stereotactic ablative radiotherapy using the Cyberknife, VMAT or Tomotherapy. Tumor-control-probabilities (TCP), normal-tissue-complication-probabilities (NTCP) were determined in a theoretical framework applying a single dose of 20 Gy (demanding 95% coverage) for intrahepatic lesions of 1-5 cm in size. We evaluated therapeutic ratios by TCP (mean dose in the lesion) relative to high-dose (conformality) or low-dose liver exposition in dependency on the lesion size for each technique. In addition, we considered treatment times and accuracy (clinical target volume vs planning target volume).
RESULTS
RESULTS
HDR-brachtherapy has the highest therapeutic ratios with respect to high-dose as well as low-dose liver exposition even for extended lesions, and the Cyberknife being suited second best. However, for lesions ≥ 3 cm diameter the therapeutic ratios of all ablative techniques are increasingly converging, and better tolerance and shorter treatment times of noninvasive external techniques become more important. On the other hand, mean tumor doses of HDR-brachytherapy of near 60 Gy are unattainable by the other techniques gaining only 22-34 Gy, and the conformality of HDR-brachytherapy is still rather good for lesions ≥ 3 cm diameter.
CONCLUSIONS
CONCLUSIONS
HDR-brachytherapy is by far the most effective technique to treat intrahepatic lesions by a single fraction, but sparing of the surroundings declines with increasing lesion size and approaches the benchmarks of external beam radiosurgery techniques. External beam radiotherapy has the advantage to use suitable fractionation schedules.
Identifiants
pubmed: 33726751
doi: 10.1186/s13014-021-01779-5
pii: 10.1186/s13014-021-01779-5
pmc: PMC7970808
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51Références
Surg Oncol Clin N Am. 2021 Jan;30(1):159-173
pubmed: 33220803
JAMA Oncol. 2015 Sep;1(6):787-95
pubmed: 26181239
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S94-100
pubmed: 20171524
J Cancer Res Clin Oncol. 2020 Sep;146(9):2351-2358
pubmed: 32356176
Radiother Oncol. 2017 May;123(2):218-226
pubmed: 28363484
Br J Surg. 2010 Jul;97(7):1110-8
pubmed: 20632280
Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):776-84
pubmed: 15936559
Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):109-22
pubmed: 2032882
Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):479-85
pubmed: 20304566
Strahlenther Onkol. 2004 May;180(5):274-80
pubmed: 15127157
Semin Radiat Oncol. 2011 Oct;21(4):287-93
pubmed: 21939858
J Vasc Interv Radiol. 2004 Nov;15(11):1279-86
pubmed: 15525748
Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):123-35
pubmed: 2032883
Semin Radiat Oncol. 2018 Oct;28(4):288-294
pubmed: 30309639
Br J Radiol. 2018 Jul;91(1088):20180058
pubmed: 29750538
Radiat Res Suppl. 1985;8:S13-9
pubmed: 3867079
J Clin Oncol. 2001 Jan 1;19(1):164-70
pubmed: 11134209
Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9
pubmed: 20171502
Lancet. 2011 Jun 18;377(9783):2060-2
pubmed: 21641637
J Clin Oncol. 2010 Jan 20;28(3):493-508
pubmed: 19841322
Radiat Oncol. 2010 May 27;5:44
pubmed: 20507615
Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):137-46
pubmed: 2032884