Journal of Cancer and Clinical Oncology

Vol. 4(1), pp. 048-056, November, 2020. © www.premierpublishers.org. ISSN: 5907-4449

Research Article

Results of Stereotactic Body Radiotherapy (SBRT) for

Management of Hepatic Tumors: Analysis of Local
Control and Survival Outcomes
*Eman ElAlfy¹, MD; Pierre-Yves Bondiau², MD, PhD.
¹Department of Cancer Management and Research, Medical Research Institute, Alexandria University, Egypt;
²Departement de Radiothérapie,, Centre Antoine – Lacassagne (CAL), Nice, France.

PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic
Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95%
for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p=
0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for
survival and LC.

Keywords: Cyberknife, Hepatocellular carcinoma, hepatic metastases, Cholangiocarcinoma, Local Control, Survival.

INTRODUCTION

Liver cancer is the sixth most commonly diagnosed cancer
and third leading cause of death worldwide, with 749,700
new cases and 696,000 deaths during 2008, its Incidence
in France is about 6 per 100,000 (Parkin DM, 2001; Ferlay
J, 2010).
While surgical resection offers 5-year survival rates of 30-
60%, only 10-30% of liver tumors are eligible for surgery,
due to advanced stage of local disease or comorbid
medical conditions (Lau WY, 2017; Fuss M, 2004). Other
therapeutic options are liver transplantation, percutaneous
alcohol ablation, transarterial chemoembolization (TACE)
and radiofrequency ablation (RFA); most of these
approaches have limitations depending on size, location,
number and distribution of lesions (Orlando A, 1997;
Horigome H, 2001).
Stereotactic body radiotherapy (SBRT) offers a treatment
option for hepatocellular carcinoma (HCC) and hepatic
metastases (HM) patients who are not eligible for other
modalities especially with use of CyberKnife; an image-
guided robotic radiosurgery system capable of detecting
and correcting intrafraction tumor motion and adapting to
patient’s breathing and moving linear accelerator in
concert with it. SBRT for HM and HCC has shown
encouraging rates of local control (LC) and low toxicity
(Ambrosino G, 2009; van der Pool AE, 2010).
*Corresponding Author: Dr. EMAN ELALFY: MBBCh,
MSc, MD. Lecturer in Cancer Management and, Research
Department, Medical Research Institute, Alexandria
University. Egypt
E-mail: eman.elalfy@alexu.edu.eg

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
ElAlfy and Bondiau 49

Preliminary results in HCC have shown the efficacy of 34 HM were from gastointestinal tract (oesophagus, colon,
using SBRT as a locally ablative modality for HCC, rectum, stomach, anal canal and, pancreas) 2 ovary, 6
specifically in those unfit for other local therapies (Choi BO, breast, 1 lung, 2 choroidal melanoma, 1 kidney, 1 thyroid
2008; Méndez Romero A, 2006; Tse RV, 2008). and, 1 carcinoma of unknown origin.

Nevertheless, its effect on survival is seldom reported. We Performance status (PS) measured according to ECOG
will present our results for 76 primary or secondary HM mostly it was 2.Median volume of PTV was 23.726 cm³,
treated with SBRT (Cyberknife) and factors associated mean PTV volume was 46.574 cm³ (range, 2.030 -
with their early outcomes such as overall survival (OS), 215.398 cm³).
disease free survival (DFS) and local control (LC).
Table (1): Patients and Treatment characteristics:
We will present our results for 76 lesions in 59 patients Total N
diagnosed with either primary hepatic malignancies or (%)
Hepato- Hepatic Cholangio-
metastases to the liver treated with SBRT (Cyberknife) and Or
carcinoma Metastases carcinoma
factors associated with their early outcomes such as Median
overall survival (OS), disease free survival (DFS) and LC. (range)
Sex:
Male 33
MATERIALS AND METHODS 8 (100%) 25 (52.1%) 0 (0%)
(55.9%)
Female 26
Patients: Between March 2007 and December 2012, 0 (0%) 23 (47.9%) 3 (100%)
(44.1%)
Medical records were retrospectively reviewed of 59 Age:
patients underwent SBRT with real-time tracking for < 65 26
primary or secondary HM. 2 (25%) 23 (47.9%) 1 (33.3%)
years (44.1%)
The ethics committee has already approved that ≥ 65 33
retrospective analysis of the liver cancer cases treated by 6 (75%) 25 (52.1%) 2 (66.7%)
years (55.9%)
SBRT. P.S.:
0 11
The selected patients shoould met the inclusion criteria 0 (0%) 11 (22.9%) 0 (0%)
(18.6%)
that were as follows: 1 21
1) ECOG performance status ≥2; (35.6%)
3 (37.5%) 17 (35.4%) 1 (33.3%)
2) all the treated lesion were confined to the liver with the
2 27
chossen residual normal liver volume to be ≥700 cc; 5 (62.5%) 20 (41.7%) 2 (66.7%)
(45.8%)
3) those unfit for other standard local therapy according
Total 45 (25- 45 (40-45) 44 (25-45) 42 (40-45)
to the liver tumor board or refusing to undergo other
Dose 45) Gy Gy Gy Gy
local treatment;
No. of
4) the selected patients have accepted and signed 3 (3-5) 3 (3-4) 3 (3-5) 3 (3-4)
fraction
informed consent to be treated with SBRT using the
CyberKnife real-time tracking system. ISO-
80% 80%
Dose 80% 80.0%
(70%- (70%-
While the Exclusion criteria were as follows : line for (77%-84%) (80%-84%)
119%) 119%)
1) patients with more than 3 liver lesions; PTV
2) those who recieved atypical dose and fractionations No. of 136 141 143 130
that not applied in our standard etracrainal SBRT beams (27-281) (97-181) (27 -281) (118-133)
protocal of treatment which is median dose of 47.61 Dose / 15 (5-15) 15 (10-15) 15 (5-15) 14 (10-15)
Gy in 3 fractions prescribed to 80 % isodose line. fraction Gy/f Gy/f Gy/f Gy/f

Treatment Planning and Delivery:

Treatment was delivered with Cyberknife system. All
patients signed Informed consent before start of treatment. Outpatients were treated with Cyberknife using Multiplan
Patients and treatment characteristics are shown in Table V3 treatment planning software and, the Synchrony
(1). Respiratory Tracking System enabling tracking of tumor
movement in real time. Total accuracy is less than 1.5 mm
Mean age was 67 years (range, 40 – 89 years), 76 lesions with Synchrony for mobile targets with treatment accuracy
were treated (45 patients with 1, 11 patients with 2 and 3 of 0.3 mm (Hoogeman M et al, 2008).
patients with 3 lesions).
Four fiducials are implanted close to the target by a
Patients presented for 48 HM, 8 HCC and 3 radiologist with a CT scan under local anesthesia before
cholangiocarcinoma (CC). the planning CT. Median time between fiducial
implantation and start of treatment was 5-10 days.

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
 J. Cancer. Clin. Oncol. 50

Gross Tumor Volume (GTV) was based on MRI image
fused on the dosimetric CT scan helped by PET scan when
needed. For HM cases; we do not use margin (clinical
target volume (CTV) = GTV + 0 mm), as according to our
center protocol that follows the logistic explanation
presumed by the Radiation Therapy Oncology Group
(RTOG) used by (Timmerman RD et al, 2018) in the
protocol of lung SBRT that did not apply margin for the
presumed microscopic extension.
For HCC and CC cases margins were 5 mm (CTV= GTV
+ 5 mm) to treat any microscopic disease extension.
Planning Target Volume (PTV) contained the CTV and 3-
mm geometric margin to account for the uncertainty.
Time was Less than one week between dosimetric CT and
start of treatment.
All time to event endpoints were calculated from the
initiation of SBRT treatment. OS: included death from any
cause. DFS: counted events as appearance of new lesions
within liver or distant relapse. LC: included events
involving pre-existing treated lesions only.
Rates were estimated using Kaplan-Meier method.
Differences among survival curves were compared using
log-rank test. Univariate analyses of LC and survival were
performed using the Cox regression model. Fisher exact
test and Pearson chi-squares methods were used to study
the association between categorical variables and
Kruskal-Wallis test for continuous variables. Pearson
correlation coefficient was used to assess association
between two quantitative variables. A p value ≤ 0.05 was
chosen as the significance threshold.

The dose was prescribed to 80% isodose line (95% of the

PTV receiving the total dose) delivered in a median of 4 RESULTS
days (range, 4 to 8 days).
For all patients the minimum and maximum doses
Patients received median dose of 47.61 Gy in 3 fractions received by organs at risk were; right kidney (1.02-20.21),
prescribed to 80 % isodose line. left kidney (0.97-5.27), spinal cord (0.96-4.69), right lung
(0.75-35.89), left lung (1.27-12.9).
Dose limitation to normal tissues:
Doses received by target volumes are presented in TABLE
Liver, kidney, lung, and spinal cord were contoured during (2).
the planning process and dose-volume histograms (DVH)
were used to ensure that normal tissue tolerances were Table (2): Doses received by the target volumes:
not exceeded. Total Hepato-
Hepatic Cholangio
Median cellular
metastases Carcinoma
Dose constraints: (range) carcinoma
Gy
Dose to medullary canal was limited to 22.5 Gy / 0.25 cc GTV:
(max 30Gy), for kidney was 18.6 Gy for 66% volume, for
liver was 21 Gy for < 700 cc (Milano MT et al, 2007). Min. 39.91 42.81 39.01 43.73
(38.59- (39.37- (38.59- (37.53-
Follow – up: 50.31) 45.09) 47.2) 50.31)
Max. 54.57 50.31 53.59
55.62
All patients had contrast - enhanced CT scan of thorax, (45.40- (45.4- (47.89-
(48- 64.28)
abdomen and pelvis at time of treatment, imaging was 64.28) 58.12) 56.25)
repeated at each follow up visit every 3 months in first 2 CTV:
years then every 6 months in next 5 years then annually Min. 38.97 42.48 38.72 37.53
with clinical examination and assessment of toxicity (38.59- (31.61- (38.59- (36.68-
according to CTCAE-3. 45.9) 45.09) 45.9) 44.75)
Max. 54.57 50.31 53.59
Statistics: 55.62
(45.4- (45.4- (47.89-
(48- 64.28)
64.28) 58.12) 56.25)
Descriptive statistics were used for categorical variables PTV:
(frequency and percentage) and continuous variables
Min. 35.77 37.87 35.55 33.85
(median and range). We analyzed: age, gender, PS,
(37.11- (27.55- (37.11- (33.06-
primary site, total dose, number of fractions, dose per
42.33) 41.71) 42.33) 40.68)
fraction, isodose line, number of beams, size of target
Median 47.61 49.88 47.51 46.72
lesion, maximum and minimum doses prescribed to the
(31.76- (43.35- (31.76- (44.2-
tumor and received by organs at risk as liver, kidneys,
52.15) 51.59) 52.15) 49.84)
lungs and spinal cord, immediate tolerance and acute
Max. 53.57 50.31 53.59
toxicity. 55.55
(45.4- (45.4- (48.09-
(48- 64.28)
64.28) 58.12) 56.25)

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
ElAlfy and Bondiau 51

Clinical outcomes:

For all patients; OS was 81.4% and 53.3% at 1 and 2 two

years, respectively (CI 95%: 12% to 50 %). (FIGURE 1).

Figure 3: Local Control (LC)

HCC; OS was 41.7% at 1 and 2 years, all patients had

distant progression before 1 year (Figure 4), LC was 75%
Figure 1: Overall Survival (OS) at 1 and 2 years.

DFS was 64.6% and 40.7% at 1 and 2 years, respectively

(CI 95%: 13.5% to 20 %). This is represented in (FIGURE
2),

Figure 4: Separated Disease-Free Survival percent

(DFS) per each lesion

HM; OS was 83.6% and 57% at 1 and 2 years respectively,

Figure 2: Disease Free Survival (DFS)
DFS was 69.5% and 46.1% at 1 and 2 years (FIGURE 4),
LC was 76.3% and, 57.9% at 1 and 2 years.
LC was 75% and 54.1% at 1 and 2 years, respectively (CI
CC; OS was 100% and 50% at 1 and 2 years respectively,
95%: 12.5% to 39 %). (FIGURE 3)
Both DFS (Figure 4) and LC were 50% at 1 year and, 0%
at 2 years.

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
 J. Cancer. Clin. Oncol. 52

Factors influencing clinical outcomes: Table (3): Radiotherapy toxicity:

Total Lesions p
We performed a univariate and multivariate analysis for all (n = 59) HCC METS Cholangio
previously mentioned variables to identify the prognostic (n = 8) (n = 48) (n = 3)
factors influencing OS, DFS and LC Immediate Tolerance and acute Toxicity
Well 57 8 46 3 (100%) 1.000
We will describe in details those with the more statistically tolerated (96.6%) (100%) (95.8%)
significant results which indicated by the p value less than (No
0.05 that lead to better local control and/or better survival Toxicity)
outcome, we found that: Asthenia 3 (5.1%) 0 (0%) 3 (6.3%) 0 (0%) 1.000
Nausea 3 (5.1%) 0 (0%) 3 (6.3%) 0 (0%) 1.000
All patients: Moderate 1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
colic
No factor influencing OS, Factor influencing DFS was dose
Back pain 1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
ranging from 40 - 44 (P= 0.040), LC affected by; number
relieved
of beams ≤ 150 (P= 0.019), coverage> 95% for GTV (P=
with
0.000), CTV (P= 0.000), PTV (P= 0.001), minimum dose >
analgesic
35 Gy for PTV (P= 0.037).
Minimal 1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
fatigue
Hepatocellular carcinoma:

OS affected by; Max dose > 55 Gy for GTV (P= 0.033),

DISCUSSION
CTV (P= 0.024), PTV (P= 0.041). No factor influencing
DFS, and for LC; coverage > 95% for PTV (P= 0.005),
minimum dose > 35 Gy for PTV (P= 0.05). Results from our retrospective study demonstrate safety
and feasibility of hypofractionated SBRT for treatment of
primary or HM. During treatment; tumors can be
Hepatic metastases:
continuously tracked by implanted fiducial markers,
allowing reduction in tumor margins. Treatment was well
OS influenced by; Age < 65 years (P= 0.033), Males (P=
tolerated with minimal grade 1 and 2 toxicity and only one
0.050), PTV volume < 50 cm3 (P= 0.002), Coverage > 95%
patient developed grade 3 toxicity (2%), this is consistent
for GTV (P= 0.041). Factors affected DFS were ; Age < 65
with other SBRT series as Carey Sampson et al. (2006)
years (P= 0.034), Males (P = 0.017), Total dose of 45 Gy
observed that morbidity of liver irradiation using SBRT was
(P= 0.001), Dose per fraction equal to 15 Gy (P= 0.001),
low independent of dose fractionation scheduled.
P.S = 2 (P= 0.024), Max dose > 55 Gy for Gtv (P= 0.000),
Katz et al. (2007) reported limited grade 1–2 acute toxicity
CTV (P= 0.000), PTV (P= 0.000), coverage > 95% for GTV
(0–29%), minimal grade 3–4 toxicity (0–5%); Choi et al.
(P= 0.048), CTV (P= 0.031), PTV (P= 0.001), minimum
(2008) found no grade 3 toxicity.
dose > 35 Gy for GTV (P= 0.032), CTV (p= 0.013), LC
While other studies as Hoyer et al. (2006) observed
affected by; Females (P= 0.013). min dose > 35 Gy for
hepatic failure leading to death, Dawson et al. (2002)
PTV (P= 0.05).

Cholangiocarcinoma:
found nineteen (9.4%) of 203 patients had developed
radiation induced liver disease RILD and reported factors
OS affected by: Max dose> 55 Gy for GTV (P = 0.033),
predicting RILD to be mean liver dose, primary liver cancer
CTV (P= 0.024), PTV (P= 0.041); No factor influencing
and male, therefore our results of low rate of toxicity can
DFS or LC.
be explained by the use of a new technology with tracking
Toxicity: capabilities.

For all patients;

Treatment was well tolerated and completed without
OS was 81.4% and 53.3% at 1 and 2 years which is
breaks for total 58 patients with minimal grade 1 or 2 acute
consistent with Erqi liu et al. (2013) they found OS was 81%
toxicity as Asthenia, Nausea, Moderate colic, Back pain
and 52% at 1 and 2 years.
and only 2% grade 3 esophageal toxicity. All are
mentioned in TABLE (3).
LC was 75% and 54.1% at 1 and 2 years which is quite
similar to Herfarth et al. (2001) that reported LC of 71%
and, 67% at 12 and, 18 months respectively but differs
from Mendez Romero et al. (2006) which resulted in 1 and
2-year LC of 94% and 82% respectively.

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
ElAlfy and Bondiau 53
Because of dose variability in these retrospective series
Hoyer et al. (2006); Mendez Romero et al. (2006) and Lee
et al. (2009) a dose response analysis documented
increased LC for a biological equivalent dose (BED) > 100
Gy that support what we found that dose >35 Gy for PTV
is influencing LC.
As dose influencing LC we found logically that coverage >
95% of target volume also influencing LC; moreover
number of beams influencing coverage factor.
Hepatocellular carcinoma;
We found OS was 41.7% at 1 and 2 years while Choi et al
[9] found OS was 70% and 43.1%, Cardenes et al. (2010)
OS was 75% and 60% at 1 and 2 years and, Tse et al.
(2008); OS was 51% at 1-year, the difference for OS at 1
year between previous studies and our results can be
explained by our low number of HCC cases.
We found LC at 1 and 2 years to be 75% which is
consistent with other series as Choi et al. (2008) found LC
was 71.9% at median follow-up 10.5 months van der Pool
et al. (2010) reported LC of 74% at 2 years. Ambrosino et
al. (2009) obtained disease control in 74.1% of cases,
While in Dewas S, et al. (2012) observed LC at 1 and 2
years of 90.5%.
There is dose–response relationship for HCC with non-
stereotactic conformal hepatic irradiation with an
increased response rate as the dose increases [Park HC,
et al. (2002). The same relationship holds when
reproduced using the millimetric tracking accuracy of
Cyberknife, in our study we found that dose superior than
35 Gy for the PTV is influencing LC.
As dose influencing LC we found coverage > 95% of target
volume influencing LC.
Hepatic Metastases;
Metastatic disease to liver remains difficult management
problem, diffuse involvement throughout the liver with or
without extra-hepatic sites of disease, carries a poor
prognosis with median survival of only 6 months, Scheele
J, et al. (1990).
Regarding metastatic hepatic lesions in the literature, the
median follow-up ranges from six to 54 months and our
median follow up was10 months (range; 1-68 months).
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
In our study OS was 83.6% and 57% at1 and 2 years. Also,
Katz et al. (2007) reported Survival was 78% and 37% at
10 and 20 months, respectively, Hoyer et al. (2006)
demonstrated 5-year survival for liver / lung metastases
from colorectal cancer to be 13%.
We observed patients with age < 65 years experienced
higher OS than older age group which explained by lower
comorbidity, also males had higher OS as most of primary
was from colorectal so they may be received previous 5-
Flurouracil chemotherapy.
We found that tumor size influenced the OS which is
discussed in other studies as Rusthoven KE, et al. (2009)
and, Wada H, et al. (2004) demonstrated that lesions less
than 3 cm have better LC, Dewas S, et al. (2012) identified
diameter and volume of GTV and PTV as prognostic
factors of LC.
In other series, stratification by size revealed no significant
difference in LC, Vautravers-Dewas C, et al. (2011) and
Chang BK, et al. (2007) found tumor size did not predict
the LC.
We found DFS was 69.5% at one year and 46.1% at two
years; LC was 76.3% and 57.9% at 1 and 2 years;
respectively. Quite similar to our study, Katz et al. (2007)
reported progression-free survival was 24% at 12 months;
LC was 76% and 57% at 10 and 20 months; respectively.
Many studies discussed the issue of dose response
relationship as McCammon R, et al. (2009) found a dose
response with increased dose of 54 Gy or greater in 3
fractions, Chang et al. [29] demonstrated that total dose,
dose per fraction and BED correlated with LC, Dewas S,
et al. (2012) found that; the only prognostic factor for LC is
the dose, also we found that a dose > 35 Gy for the PTV
is influencing LC, while Vautravers-Dewas C, et al. (2011)
did not demonstrate any dose response.
Cholangiocarcinoma;
We found OS was 100% at one year and 50% at two years.
Both DFS and LC were 50% at one year and 0% at two
years, and Kopek N, et al. (2010) reported median
progression-free survival was 6.7 months and OS was
10.6 months for unresectable CC.
All are summarized in TABLE (4).
 J. Cancer. Clin. Oncol. 54

Table (4): Overview of studies of stereotactic body radiation therapy for liver lesions:
Study No. of No. RT No. of Tumor Follow up Local control Design
lesions of dose fractions volume/ period (outcome)
Pts. (Gy) (Fx) Lesion size median at 1 and 2
(medians) in months years
Ambrosino et al. HM (n = 27) 27 25-60 3 69 cc/- 13 (6-16) 85.2% Retrospective
2009 overall control CyberKnife
Van der Pool et HM CRC 20 37.5 3 -/23 mm 26 (6-57) -/74 -
al. 2010 (n = 31)
Choi et al. 2008 HCC 31 30-39 3 25 cc/- 10.5 71.9% Retrospective
(n = 32. (2 – 18.5) at the median CyberKnife
including of 10.5 months
9 PT)
Mendez et al. HCC 25 25– 3-5 22 cc/32 mm 12.9 94/82 Phase I/II
2006 (n = 11) 37.5 (1.1–322) 75/75 (HCC) Body Frame
HM (n = 34) 100/86 (HM)
Katz et al. 2007 HM (n = 174) 69 30-55 7-20 9.9 cc/27 mm 14.5 76/57 Retrospective
Exac Trac
Hoyer et al. 2006 HM CRC 64 45 3 -/35 4.5 years -/79 Phase II
(n = 44) Body Frame
Liu et al 2013 106 62 60-50 3-5 88 mm 18 93/82 Retrospective
study
Herfarth etal. HCC + CC 37 14-26 1 10 cc/- - 67/- Phase I/II
2001 (n = 4)
HM (n = 56)
Lee et al. 2009 HM (n = 68) 68 27-60 6 75.2 cc/- 10.8 71/- Phase I
Respiration
control
Cardenes et al HCC(n=25) 17 36-48 3 34 cc/40 mm 24(10-42) 100% Phase I
2010 Cyberknife
Dewas et al . 153 120 27-48 2-4 73 cc/48 mm 15(12-18) 80.4/72.5 Retrospective
2012 HCC (n=48) Cyberknife
HM(n=99)
CC(n=6)
Rusthoven et al. HM (n = 63) 47 60 3 15 cc/27 mm 16 95/92 Phase I/II
2009
Wada et al. 2004 HM 5 45 3 NR 71.2(2y) Retrospective
Vautravers- 62 HM 42 40-45 4-3 34 mm 14.3 86(2y) -
Dewas et al. 2011
Chang et al. 2007 102 65 22-60 30.1 mm 14.4 62/45 Retrospective
McCammon et al. 246 141 >54-36 - - - 89.3(3y) Retrospective
2009
Kopek et al. 2010 - 27 45 3 - 5.4 ys 81.5 -

ACKNOWLEDGEMENT CONCLUSIONS

The authors acknowledge Mrs. Laurence Milan;
Cyberknife/Cyclotron, Department of Radiotherapy,
Centre Antoine-Lacassagne (CAL), Nice, France; for her
valuable contribution during and beyond the conduct of
this study.
Our results demonstrate that robotic SBRT (Cyberknife) is
an effective modality with good LC and low morbidity for
primary and secondary HM.
Factors influencing the survival and LC in our study are:
age < 65 years, sex, P.S., volume of tumor and PTV,
coverage of target volume, total dose and dose per
fraction.

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
ElAlfy and Bondiau 55
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Accepted 7 November 2020

Citation: ElAlfy E, Bondiau P (2020). Results of

Stereotactic Body Radiotherapy (SBRT) for Management
of Hepatic Tumors: Analysis of Local Control and Survival
Outcomes. Journal of Cancer and Clinical Oncology 4(1):
048-056.

Copyright: © 2020: ElAlfy and Bondiau. This is an open-

access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original author and source are cited.

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes