Introduction
Materials and methods
Patients
Planning and treatment
Organ | Dose constraints |
---|---|
Liver | V21 < 33% |
Spinal cord | Dmax < 22 Gy |
Kidney | V15 < 33% |
Stomach | V21 < 5 cm3 |
Duodenum | V15 < 5 cm3 |
Dmax < 24 Gy | |
Small intestine | V16 < 5 cm3 |
Dmax < 27 Gy |
Follow-up
Statistics
Results
Patient and treatment characteristics
Total N (%) or Median (range) | Hepatocarcinoma | Hepatic metastases | Cholangiocarcinoma | p* | |
---|---|---|---|---|---|
Sex
| |||||
Male
|
78 (65%)
| 32 (76.2%) | 42 (58.3%) | 4 (66.7%) |
0.14
|
Female
|
42 (35%)
| 10 (23.8%) | 30 (41.7%) | 2 (33.3%) | |
Age
|
67 (23--85)
| 69 (43--85) | 64 (23--83) | 70 (62--78) |
0.16
|
Weight (kg):
|
78 (43--120)
| 83 (47--120) | 74.5 (43--115) | 73 (68--85) |
0.07
|
BMI
|
26.1 (14.2--43.3)
| 29 (20.5--40.6) | 25.6 (14.2--43.3) | 27.1 (23.5--32) |
0.03
|
WHO
| |||||
0
|
92 (77.3%)
| 31 (73.8%) | 58 (81.7%) | 3 (50%) | |
1
|
23 (18.5%)
| 11 (26.2%) | 9 (12.7%) | 2 (33.3%) |
0.08
|
2
|
4 (3.4%)
| 0 | 3 (4.2%) | 1 (16.7%) | |
3
|
1 (0.8%)
| 0 | 1 (1.4%) | 0 | |
Prior treatments
|
114 (95%)
| 19 (45.2%) | 66 (91.7%) | 3 (50%) |
< 0.001
|
Radiofrequency
|
11 (9.2%)
| 2 (4.8%) | 9 (12.5%) | 0 |
0.38
|
Surgery
|
31 (25.8%)
| 4 (9.5%) | 24 (33.3%) | 3 (50%) |
0.003
|
Chemo--embo
|
8 (6.7%)
| 6 (14.3%) | 2 (2.8%) | 0 |
0.11
|
Radiotherapy
|
2 (1.7%)
| 1 (2.4%) | 1 (1.4%) | 0 |
0.87
|
Chemotherapy
|
62 (51.7%)
| 6 (14.3%) | 54 (75%) | 2 (33.3%) |
< 0.001
|
Hepatic volume (cm
3
)
|
1548 (843–2940)
| 1614 (908–2611) | 1499 (843–2940) | 1783 (1607–2018) |
0,19
|
Targets size (Sum in mm per patient)
|
45 (8–159)
| 40(17–145) | 45 (8–159) | 63 (36–112) |
0,24
|
Total N (%) or Median (range) | Hepatocarcinoma | Hepatic metastases | Cholangiocarcinoma | p* | |
---|---|---|---|---|---|
Sum of GTV volumes (cm
3
)
|
32.9 (0.2--499)
| 47.5 (1.4--499) | 25.6 (0.2--245) | 261 (8--371) |
0.029
|
Ratio of the volume of GTV to the Liver
|
0.02 (0--0.32)
| 0.03 (0--0.3) | 0.02 (0--0.2) | 0.1 (0--0.2) |
0.028
|
Ratio of the volume of PTV to the Liver
|
0.08 (0--0.38)
| 0.09 (0--0.38) | 0.05 (0--0.37) | 0.2 (0--0.3) |
0.074
|
Session length (min)
|
107 (35--199)
| 107 (35--156) | 107 (41--199) | 100 (74--151) |
0.831
|
Number of beams (median)
|
150 (25--276)
| 148 (29--254) | 149 (25--276) | 182 (105--226) |
0.449
|
Total dose (Gy)
|
45 (27--45)
| 45 (27--45) | 45 (27--45) | 45 (29--45) |
0.321
|
-- 45 Gy: 15 Gy x 3 | -- 45 Gy: 15 Gy x 3 | -- 45 Gy: 15 Gy x 3 | |||
-- 39 Gy: 13 Gy x 3 | -- 40 Gy: 10 Gy x 4 | -- 40 Gy: 10 Gy x 4 | |||
-- 36 Gy: 12 Gy x 3 | -- 39 Gy: 13 Gy x 3 | -- 39 Gy: 13 Gy x 3 | |||
-- 30 Gy: 15 Gy x 2 | -- 36 Gy: 12 Gy x 3 | ||||
-- 30 Gy: 10 Gy x 3 | -- 30 Gy: 10 Gy x 3 | ||||
-- 27 Gy: 9 Gy x 3 | |||||
Dose per fraction (Gy)
|
15 (9--15)
| 15 (9--15) | 15 (9--15) | 15 (10--15) |
0,026
|
Local control
Local control per target at 1 year (%) | Local control per target at 2 years (%) | p* | |
---|---|---|---|
Total dose
| |||
= 45 Gy
| 92.3 (82.1 – 96.8) | 79.1 (61.6 – 89.3) | |
< 45 Gy
| 72.0 (56.4 – 82.8) | 66.5 (50.3 – 78.5) |
0.019
|
Target diameter
| |||
> 50 mm
| 74.6 (54.6 – 86.8) | 63.0 (39.8 – 79.3) | |
< 50 mm
| 87.5 (77.9 – 93.1) | 78.8 (65.9 – 87.3) |
0.019
|
GTV volumes
| |||
> 100 cc
| 81.8 (58.5 – 92.8) | 62.3 (31.0 – 82.6) | |
< 100 cc
| 84.4 (74.9 – 90.5) | 76.8 (64.9 – 85.0) |
0.063
|
PTV volumes
| |||
> 200 cc
| 72.6 (50.3 – 86.2) | 59.9 (35.3 – 77.7) | |
< 200 cc
| 87.2 (78.0 – 92.8) | 79.0 (66.7 – 87.2) |
0.014
|
Discussion
Hepatocellular carcinoma
Study
|
No. of lesions
|
No. of patients
|
Total dose (Gy)
|
No. of fractions
|
Lesion volume/Lesion size (medians)
|
Post-treatment period median in months
|
Local control at 1 and 2 years
|
Comments
|
---|---|---|---|---|---|---|---|---|
Blomgren et al. 1998[20] | HCC and CC (n = 20) | 41 | 30 | 2-3 | 22 cc/- | 11 | 100% overall control | Retrospective |
HM (n = 21) | 24 cc/- | 95% overall control | ||||||
Herfarth et al. 2001[13] | HCC + CC (n = 4) | 37 | 14-26 | 1 | 10 cc/- | - | 67/- | Phase I/II |
HM (n = 56) | ||||||||
Fuss et al. 2004[21] | HCC (n = 1) | 15 | 36 | 3-6 | 56 cc/- | 6.5 | 94/- | Retrospective |
HM (n = 17) | ||||||||
Schefter et al. 2005 (27) | HM (n = 18) | 18 | 36-60 | 3 | 18 cc/- | - | - | Phase I |
Body Frame | ||||||||
Mendez et al. 2006[22] | HCC (n = 11) | 25 | 25–37.5 | 3-5 | 22 cc/32 mm | 12.9 (1.1–322) | 94/82 | Phase I/II |
Body Frame | ||||||||
75/75 (HCC) | ||||||||
HM (n = 34) | 100/86 | |||||||
(HM) | ||||||||
Wulf et al. 2006[6] | HCC + CC (n = 5) | 44 | 21-36 | 1-3 | - | 15 | 92/66 | Phase I |
Body Frame | ||||||||
HM (n = 39) | ||||||||
Hoyer et al. 2006[23] | HM CRC (n = 44) | 64 | 45 | 3 | -/35 | 4.5 years | -/79 | Phase II |
Body Frame | ||||||||
Kavanagh et al. 2006[24] | HM (n = 36) | 36 | 60 | 3 | 14 cc/6 | 19 | 93% at 18 months | Phase I/II |
Body Frame | ||||||||
Katz et al. 2007[25] | HM (n = 174) | 69 | 30-55 | 7-20 | 9.9 cc/27 mm | 14.5 | 76/57 | Retrospective |
Exac Trac | ||||||||
Tse et al. 2008[26] | HCC + CC (n = 31 + 10) | 41 | 24–54 | 6 | 173 cc | 17.6 (10.8 – 39.2) | 65% | Phase I |
Respiration control | ||||||||
Choi et al. 2008[7] | HCC (n = 32. including 9 PT) | 31 | 30 – 39 | 3 | 25 cc/- | 10.5 (2 – 18.5) | 71.9% at the median of 10.5 months | Retrospective |
CyberKnife | ||||||||
Rusthoven et al. 2009[15] | HM (n = 63) | 47 | 60 | 3 | 15 cc/27 mm | 16 | 95/92 | Phase I/II |
Lee et al. 2009[27] | HM (n = 68) | 68 | 27-60 | 6 | 75.2 cc/- | 10.8 | 71/- | Phase I |
Respiration control | ||||||||
Ambrosino et al. 2009[1] | HM (n = 27) | 27 | 25-60 | 3 | 69 cc/- | 13 (6–16) | 85.2% overall control | Retrospective |
CyberKnife | ||||||||
Goodman et al. 2009[3] | HCC + CC (n = 7) | 26 | 18-30 | 1 | 33 cc/- | 17.3 (2–55) | 77/- | Phase I |
CyberKnife | ||||||||
HM (n = 19) | ||||||||
Van der Pool et al. 2010[4] | HM CRC (n = 31) | 20 | 37.5 | 3 | -/23 mm | 26 (6–57) | -/74 | Retrospective |
Body Frame | ||||||||
Cardenes et al. 2010[28] | HCC (n = 25. including 3 PT) | 17 | 36-48 | 3 | 34 cc/40 mm | 24 (10–42) | 100% | Phase I |
CyberKnife | ||||||||
Present study 2010 | 153 | 120 | 27-45 | 2-4 | 73 cc/48 mm | 15 (12–18) | 80.4/72.5 | Retrospective |
CyberKnife | ||||||||
HCC (n = 48. including 3 PT) | 42 | 27-45 | 2-3 | 87 cc/48 mm | 13.7 | 90.5/90.5 | ||
73.3/67.4 | ||||||||
HM (n = 99) | 72 | 30-45 | 3-4 | 54 cc/47 mm | 15.5 | 100/- | ||
CC (n = 6) | 6 | 39-45 | 3-4 | 208 cc/65 mm | 11 |