Helical tomotherapy for chemo-refractory multiple liver metastases

Abstract

Background: Despite advances in chemotherapy, curing multiple liver metastases is quite rare. Even when response is obtained, regrowth of the tumors is almost inevitable. We aimed to evaluate the efficacy and adverse events of helical tomotherapy for chemo-refractory multiple liver metastases.

Methods: Forty-five patients with chemo-refractory multiple (3-10) liver metastases after standard systemic chemotherapy entered the single-institutional prospective study. Liver metastases were the major disease; however, 31 also had uncontrolled primary lesions and/or other metastases. The prescribed dose was 55 Gy in 25 fractions. The median planning target volume (PTV) and normal liver volume (NLV) of first treatment were 128 cm³ and 1175 cm³ , respectively. The median of V_15Gy , V_30Gy , and mean dose to NLV were 45%, 23%, and 19.4 Gy, respectively.

Results: Forty-two patients (93%) completed the planned treatment. Median survival time (MST) for all patients was 8 months, and the 1-year survival rate was 29%. The median local control (LC) period was 5 months and the 6-month control rate of irradiated tumors was 33%. A ≥30% decrease in tumor markers was observed in 31%. The most common grade 3 toxicity was lymphocytopenia (40%), followed by fatigue (6%). Radiation-induced liver disease (RILD) was not observed. Pancreatic cancer as the primary tumor, distant metastases outside the liver, low pretreatment neutrophil-to-lymphocyte ratio (NLR), and low pretreatment monocyte-to-lymphocyte ratio (MLR) were associated with poorer prognoses.

Conclusions: Helical tomotherapy for chemo-refractory multiple liver metastases is a feasible and potentially effective treatment. Incorporating tomotherapy into the first-line treatment in combination with systemic chemotherapy should be considered.

Trial registration number: CROG 12005.

Keywords: chemo-refractory; dendritic cell-based vaccine therapy; helical tomotherapy; intensity-modulated radiation therapy; multiple liver metastases.