DOI QR코드

DOI QR Code

Whole Liver Palliative Radiotherapy for Patients with Massive Liver Metastases

  • 발행 : 2015.10.06

초록

Background: The purpose of this retrospectively study was to examine the effectiveness and tolerability of a radiotherapy technique for the palliation of symptomatic liver metastases. Materials and Methods: Twentyseven patients with liver metastases were enrolled and received targeted whole liver irradiation consisting of mean 1, 8 Gy in five to twelve fractions to a total mean dose 17Gy. Symptoms at baseline were hepatic pain (26 patients), lost of weight (6), lack of appetite (2), and night sweats (1). Seventeen patients (63%) had failed previous treatment with chemotherapy and/or high-dose steroids. Results: Individual symptom response rates were 100% at 4 weeks. Partial or complete global symptomatic responses were noted in 11 patients (40%) after 2 months. After 3 months, 8 patients (28%) reported loss of pain. The treatment was well tolerated with one patient (3%) experiencing grade 3 toxicity (one vomiting and one diarrhoea). Overall the median survival time was 4.9 months (range 1 - 14 months). One year survival was 39%. Conclusions: This is simple and well-tolerated treatment but to achieve good palliation effects we should carefully selected patients whose conventional treatment does not bring good analgesic control.

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참고문헌

  1. Bengtsson G, Carlsson G, Hafstrom L (1981). Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg, 141, 586-9 https://doi.org/10.1016/0002-9610(81)90057-X
  2. Borgelt BB, Gelber R, Brady LW, Griffin T, et al (1981). The palliation of hepatic metastases: results of the radiationtherapy oncology group pilot study. Int J Radiat Oncol Biol Phys, 7, 587-91 https://doi.org/10.1016/0360-3016(81)90370-9
  3. Cokmert S, Ellidokuz H, Demir L et al (2014). Survival outcomes of liver metastasectomy in colorectal cancer cases: a singlecenter analysis in Turkey. Asian Pac J Cancer Prev, 15, 5195-200 https://doi.org/10.7314/APJCP.2014.15.13.5195
  4. Cunningham SC, Choti MA, Bellavance EC, Pawlik TM (2007). Palliation of hepatic tumors. Surg Oncol, 16, 277-291 https://doi.org/10.1016/j.suronc.2007.08.010
  5. Chua TC, Liauw W, Koong HN, et al (2011). Surgical therapies in metastatic colorectal cancer with a potential for cure. Am J Clin Oncol, 34, 326-31 https://doi.org/10.1097/COC.0b013e3181dbb9ad
  6. Chung KY, Kemeny N, (2005). Regional and systemic chemiotherapy for primary hepatobiliary cancers and for colorectal cancer metastatic to the liver. Semin Radiat Oncol, 15, 284-298 https://doi.org/10.1016/j.semradonc.2005.04.007
  7. Eble MJ, Gademann G, Wannenmacher M (1993). The value of radiotherapy for liver metastases. Strahlenther Onkol, 169, 459-68
  8. Gallinger S, Biagi JJ, Fletcher GG, et al (2013). Liver resection for colorectal cancer metastases. Curr Oncol, 20, 255-65 https://doi.org/10.3747/co.20.1341
  9. Hoyer M, Swaminath A, Bydder S, et al (2012). Radiotherapy for liver metastases: a review of evidence. Int J Radiat Oncol Biol Phys, 82, 1047-57. https://doi.org/10.1016/j.ijrobp.2011.07.020
  10. Krishan S, Lin EH, Gunn GB, Chandra A, et al (2006). Conformal radiotherapy of the dominant liver metastasis: a viable strategy for treatment of unresectable chemotherapy refractory colorectal cancer liver metastases. Am J Clin Obcol, 29, 562-7 https://doi.org/10.1097/01.coc.0000236210.41199.91
  11. Lochan R, White S, Manas DM (2007). Liver resection for colorectal liver metastasis. Surg Oncol, 16, 33-45
  12. Malik HZ, Gomez D, Wong V, Al-Mukthar A, (2007). Predictors of early disease recurrence following hepatic resection for colorectal cancer metastasis. Eur J Surg Oncol, 33,1003-9 https://doi.org/10.1016/j.ejso.2007.01.005
  13. Mendez Romero A, Hoyer M.(2012).Radiation therapy for liver metastases. Curr Opin Support Palliat Care, 6, 97-102 https://doi.org/10.1097/SPC.0b013e32834de6d8
  14. Nordlinger B, Rougier P (2002). Liver metastases from colorectal cancer: the turning point. J Clin Oncol, 20, 1442-5
  15. Prasad B, Lee MS, Hendrickson FR (1977). Irradiation of hepatic metastases. Int J Radiat Oncol Biol Phys, 2, 129-32 https://doi.org/10.1016/0360-3016(77)90018-9
  16. Russell AH, Clyde C, Wasserman TH, et al (1993). Accelerated hyperfractionated hepatic irradiation in the management of patients with liver metastases: results of the RTOG dose escalating protocol. Int J Radiat Oncol Biol Phys, 27, 117-23.
  17. Sherman DM, Weichselbaum R, Order SE, Cloud L, et al (1978). Palliation of hepatic metastasis. Cancer, 41, 2013-7 https://doi.org/10.1002/1097-0142(197805)41:5<2013::AID-CNCR2820410549>3.0.CO;2-T
  18. Suwinski R, Wydmanski J, Pawelczyk I et al (2006). A pilot study of accelerated preoperative hyperfractionated pelvic irradiation with or without low-dose preoperative prophylactic liver irradiation in patients with locally advanced rectal cancer. Radiother Oncol, 80, 27-32 https://doi.org/10.1016/j.radonc.2006.05.001
  19. Tree AC, Khoo VS, Eeles RA, et al (2013). Stereotactic body radiotherapy for oligometastases. Lancet Oncol, 14, 28-37 https://doi.org/10.1016/S1470-2045(12)70597-1
  20. Turek-Maischeider M, Kazem I (1975). Palliative irradiation for liver metastases. JAMA, 232, 625-8 https://doi.org/10.1001/jama.1975.03250060021014
  21. Yin H, Lu K, Qiao WB et al (2014). Whole-liver radiotherapy concurrent with chemotherapy as a palliative treatment for colorectal patients with massive and multiple liver metastases: a retrospective study. Asian Pac J Cancer Prev, 15, 1597-602 https://doi.org/10.7314/APJCP.2014.15.4.1597