Wstępna ocena tolerancji i skuteczności miejscowej pozaczaszkowej radiochirurgii u chorych z guzami przerzutowymi i pierwotnymi wątroby

Abstract

Author(s): BOŻENA JOCHYMEK, ALEKSANDRA GRZĄDZIEL, HUBERT URBAŃCZYK, ROLAND KULIG, MARCIN MATUSZEWSKI, EDYTA WOLNY, LESZEK MISZCZYK

Introduction: Surgical resection and chemiotherapy is a standard therapeutic modality for patients with hepatic tumors. However many patients are medically unfit for such kind of treatment. Extracranial stereotactic radiosurgery can become a new theurapeutic option for this patients.

Purpose: Evaluation of tumor response and treatment tolerance of extracranial stereotactic radiosurgery of hepatic tumors patients.

Material end method: Material comprised of 29 patients (14 women and 15 men) aged 40-80 years (mean 62 ) with 47 hepatic metastases and 2 hepatic primary tumors which were treated using extracranial stereotactic radiosurgery. Total doses varied from 6 Gy to 36 Gy and were delivered using 5 to 10 beams. Volumes of tumors varied from 0.8 to 179.4 cc. In 16 cases extra cranial stereotactic radiosurgery with respiratory gating were used. In 41 cases tumors were irradiated using single dose varied from to 6 Gy to 15 Gy. In 8 cases patents were irradiated three times with fraction dose of 12 Gy to the total dose of 36 Gy in overall treatment time of 15 days. Because of relatively short follow up period only treatment toxicity and tumor response (changes of tumor dimensions) were evaluated.

Results: The therapy was performed with no significant adverse symptoms. Vomits were observed in one case (patient with primary liver tumor - volume 116 cm3). 8 tumors decreased after radiosurgery without gating and 10 tumors progressed after the treatment, 15 tumors were lost from follow up. 6 tumors decreased after gated radiosurgery and no tumors progressed after this treatment. 10 tumors treated with gating are before the first control examination.

Conclusion: Stereotactic irradiation of hepatic metastases could be a valuable, non-invasive palliative treatment modality with slight acute toxicity and acceptable local effectiveness, for patient with hepatic tumors, who are not suitable for surgery and/or chemotherapy. Effectiveness of radiosurgery with gating could be better than radisurgery alone but is more timeconsuming. Based on our initiated experience the role of extracranial stereotactive radiotherapy should be investigated.

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