Liver Re-irradiation for Patients With Hepatocellular Carcinoma and Liver Metastasis

Publication date: Available online 26 April 2018
Source:Practical Radiation Oncology
Author(s): Susan G.R. McDuff, Kyla A. Remillard, Hui Zheng, Ann C. Raldow, Jennifer Y. Wo, Christine E. Eyler, Lorraine C. Drapek, Lipika Goyal, Lawrence S. Blaszkowsky, Jeffrey W. Clark, Jill N. Allen, Aparna R. Parikh, David P. Ryan, Cristina R. Ferrone, Kenneth K. Tanabe, John A. Wolfgang, Andrew X. Zhu, Theodore S. Hong
PurposeTo assess the safety and efficacy of administering liver re-irradiation to patients with primary liver tumors or liver metastasis.Methods and Materials49 patients (with 64 individual tumors) who received liver re-irradiation at our institution between 6/2008 and 12/2016 were identified for retrospective review. Patients were treated to the same, different, or combination of previously treated liver tumors for recurrent primary (53%) or metastatic (47%) disease using photons or protons. Clinical and treatment-related factors were compiled, and patients were monitored for toxicity and evidence of "classic" or "non-classic" RILD. Survival was estimated via the Kaplan-Meier method, and cumulative incidence of local failure (LF) used to estimate LF (using RECIST 1.1).ResultsMedian age at re-irradiation was 72 years and median interval between radiation courses was 9 months. At a median follow-up of 10.5 months, 36 (73%) patients had died, 9 (18%) were alive, and 4 (8%) were lost to follow-up. Median survival for the cohort was 14 months. Overall one-year estimate of LF was 46.4%. One-year estimates of LF for liver metastases and HCC were 61.0% and 32.5%, respectively. Average prescription dose was similar between re-irradiation and initial courses (EQD2: 65.0 versus 64.3 Gyα/β=10, respectively), but average dose to the untreated liver was lower at re-irradiation (EQD2: 10.5 versus 13.9 Gyα/β=3, respectively, p = 0.01). Among hepatocellular carcinoma patients, the average normal liver dose was significantly larger for patients who exhibited a worsening of Child-Pugh score following re-irradiation compared to those who did not (1210 cGy versus 759 cGy, p = 0.04). 85.7% experienced grade 1-2 toxicity, 4.1% developed grade 3 toxicity, and only two patients met criteria for RILD (4.1%) following re-irradiation.ConclusionsLiver re-irradiation may be an effective and safe option for select patients, however further prospective study is necessary to establish treatment guidelines and recommended dosing.



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