Solutions that enable ablative radiotherapy for large liver tumors: Fractionated dose painting, simultaneous integrated protection, motion management, and computed tomography image guidance

Christopher H. Crane, Eugene J. Koay

Research output: Contribution to journalReview article

36 Scopus citations

Abstract

The emergence and success of stereotactic body radiation therapy (SBRT) for the treatment of lung cancer have led to its rapid adoption for liver cancers. SBRT can achieve excellent results for small liver tumors. However, the vast majority of physicians interpret SBRT as meaning doses of radiation (range, 4-20 Gray [Gy]) that may not be ablative but are delivered within about 1 week (ie, in 3-6 fractions). Adherence to this approach has limited the effectiveness of SBRT for large liver tumors (>7 cm) because of the need to reduce doses to meet organ constraints. The prognosis for patients who present with large liver tumors is poor, with a median survival ≤12 months, and most of these patients die from tumor-related liver failure. Herein, the authors present a comprehensive solution to achieve ablative SBRT doses for patients with large liver tumors by using a combination of classic, modern, and novel concepts of radiotherapy: fractionation, dose painting, motion management, image guidance, and simultaneous integrated protection. The authors discuss these concepts in the context of large, inoperable liver tumors and review how this approach can substantially prolong survival for patients, most of whom otherwise have a very poor prognosis and few effective treatment options. Cancer 2016;122:1974–86.

Original languageEnglish (US)
Pages (from-to)1974-1986
Number of pages13
JournalCancer
Volume122
Issue number13
DOIs
StatePublished - Jul 1 2016

Keywords

  • gating
  • hepatoma
  • image-guided radiation therapy (IGRT)
  • intrahepatic cholangiocarcinoma
  • stereotactic ablative radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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