Third time re-irradiation of liver metastasis with robotic radiosurgery: a case series

Abstract

Re-irradiation (Re-RT) in liver tumours is rarely reported owing to poor tolerance of liver and high incidence of radiation induced liver disease incidence. Fiducial based robotic radiosurgery allows to deliver high dose radiation to the liver tumour and restricts the dose to healthy uninvolved liver, thereby increasing the potential for Re-RT. Tolerance to radiation is low for entire liver and hence re-radiation is a challenge. On the other hand, as regenerative potential of hepatocytes is rapid, replacement of necrotic liver tissue occurs with regenerated hepatocytes. These regenerated hepatocytes are radiation naïve, do not have “memory” of radation therapy treatment and hence have potential of Re-RT. We are reporting a series of two breast cancer patients presented with liver oligometastasis treated with fiducial based CyberKnife system (CK). Both the patients were treated multiple times with CK and had long-term survival (> 2 years) without any clinical features of radiation induced liver injury. Appropriately selected patients are suitable for multiple sessions of CK for liver lesions with long-term outcome.

Keywords

Liver lesions / re-radiation / robotic radiosurgery

References

[1] Seol SW,Park HC,Oh D.Treatment outcome of hepatic re-irradiation in patients with hepatocellular carcinoma..Radiat Oncol J2015;33:276-83 PMCID:PMC4707210

[2] Farach A,Teh BS.Liver regeneration following repeat SBRT..J Gastrointest Oncol2015;6:E2-E6 PMCID:PMC4311083

[3] Dawson LA.Partial volume tolerance of the liver to radiation..Semin Radiat Oncol2005;15:279-83

[4] Jackson A,Bentzen SM,Yorke ED.The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome..Int J Radiat Oncol Biol Phys2010;76:S155-60 PMCID:PMC2854159

[5] Reed GB Jr.The human liver after radiation injury. A form of veno-occlusive disease..Am J Pathol1966;48:597-611 PMCID:PMC1916442

[6] Høyer M.Re-irradiation with stereotactic body radiation therapy (SBRT)..Chin Clin Oncol2017;6:S15

[7] McDuff S,Wo JY.Safety and Tolerability of Liver Re-Irradiation..J Radiat Oncol Biol Phys2017;99:E171

[8] Raldow A,Wolfgang JA,Hong TS.Tolerability of Liver Re-irradiation With Stereotactic Radiation Therapy..J Radiat Oncol Biol Phys2014;90:S374

[9] Caudell JJ,Riaz N.Volume, dose and fractionation consideration for IMRT-based reirradiation in head and neck cancer: A multi-institutional analysis..Int J Radiat Oncol Biol Phys2018;100:606-17

[10] Yoo TG,Broom R.Systematic review of early and long-term outcome of liver resection for metastatic breast cancer: Is there a survival benefit?.Breast2017;32:162-72