DOSE VOLUME EFFECTS OF STEREOTACTIC BODY RADIOTHERAPY (SBRT) IN LIVER

TUMORS- A STUDY ON PRIMARY AND METASTATIC LIVER TUMOURS

Jeevi Mona Priyadharshni, DNB1 I Deepak Kumar Mittal, MD1 I Anil Kumar Anand, MD1 I Naveen Kumawat2 I A
K Bansal, PhD2

1 Department of Radiation Oncology , Max Super Speciality Hospital , Saket, New Delhi
2 Division of Medical Physics, Max Super Speciality Hospital, Saket, New Delhi

Introduction: SBRT is a technique that enables accurate delivery of ablative high doses of radiation in
a short time with hypo-fractionation, the advantage being reduction of dose to normal tissue and
maximizing tumor coverage because dose delivered rapidly falls off at the periphery of target lesions
through use of accurate tumor localization, motion management techniques, patient immobilization and
image guidance technique.

Objectives: Although SBRT can be effective for establishing local control in hepatic malignancies, a
tradeoff exists between tumor control in relation to the volume of the tumour and normal tissue
complications. Our objective is to present data on series of patients treated with SBRT for both primary
and metastatic liver tumours in terms of survival, local control and acute toxicity including RILD.

Material & Methods: Between October 2015 to September 2019, we treated 50 patients of liver tumors.
Patients who had normal liver volume < 700 cc were excluded. Pretreatment and post-treatment Child
Pugh(CP) score was recorded. CT simulation was done using Siemens Somatom with 2 mm cuts and
treatment was delivered using Novolis-Tx Radiosurgery (6 MV photons) system. According to lesion
size and OAR constraints, prescription regimens ranged from: 35–54 Gy in 3 to 10 fractions. Dosimetry
was evaluated from Eclipse planning system. Response assessment was by mRECIST criteria. Toxicity
evaluation was by CTCAEv5.0.during treatment and until 3 months post SBRT.

Results: All the patients were CP A or B. Median tumour volume was 86.6 cc (6.8 - 867.17 cc). Median
normal liver volume (Liver - PTV) was 1174.8.3 cc (717.33 – 2782.17 cc). Median dose delivered was
48 Gy (35 - 54 Gy) .The median BED10Gy was 85.5 Gy10 (52.2 - 151.2 Gy10). Median Dmean of normal
liver dose was 10 Gy (3 -23 Gy), Median D700cc was 9.8 (1 – 30 Gy). 3 patients expired before analysis
and were excluded from the study. Toxicities observed were fatigue, nausea/vomiting, abdominal pain
and hematological toxicities managed symptomatically. Grade ≥ 3 toxicity was seen in < 5 % of the
patients. Nausea/vomiting had significant correlation with dose per fraction (p=0.009) and dose per
freaftion (p=0.05). Non-classic RILD was seen in 1 (2 %) patient. The GTV volume (< 100 cc) and BED
(≥ 71 Gy10) had significant correlation with local control at 3 months (p=0.04) and not at further months.
There was no statistical significance between GTV volume (< 100 vs.>101 cc), BED (< 70 vs.≥71 Gy 10),
primary versus metastatic disease in respect to local control. Studies reported median OS in the range
of 6.4 to 10.6 months and 1 year local control in the range of 43–72 %. In our study, median OS was 12
months and 1 year LC was 42 %.

Conclusions: We conclude that SBRT is feasible in all liver tumours of variable sizes; the surrounding
organs at risk and adequate sparing of normal liver could be achieved with minimum acute morbidity.
We were able to achieve equivalent local control rates in both primary and metastatic liver tumours
irrespective of the size of the tumor.