#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#
CS
proLékaře.cz / Journals / Perspectives in Surgery / 2019 - 10

Comparison of surgical intervention to Cyberknife® radiotherapy in the treatment of liver malignancies

Czech version

Authors: J. Roman 2;  P. Vávra 1,2;  T. Ekrtová 1;  E. Skácelíková 1,3;  P. Ihnát 1,2;  M. Papalová 1;  S. Řehořková 1;  J. Cvek 1,3
Authors‘ workplace: Lékařská fakulta, Ostravská univerzita 1;  Chirurgická klinika, Fakultní nemocnice Ostrava 2;  Onkologická klinika, Fakultní nemocnice Ostrava 3
Published in: Rozhl. Chir., 2019, roč. 98, č. 10, s. 408-413.
Category: Original articles

Overview

Introduction: Surgical resection is the method of choice in treating liver malignancies. In patients who are not suitable for radical surgical treatment, the radiotherapeutic system Cyberknife® is a viable treatment option. The aim of this study is to compare short- and long-term results of both treatment methods.

Methods: A retrospective analysis of prospectively collected data was performed, focused on patients undergoing treatment of liver malignancies either by surgical resection or by the Cyberknife® system from 2013 to 2016. Only patients treated using a single treatment method were included in the study.

Results: A total of 260 patients were analysed; 142 were treated by performing surgical resection and the remaining 118 using Cyberknife® radiotherapy. Median survival was 30.65 months for the surgical resection and 22.93 for the Cyberknife® therapy; median overall survival was 27.63 months. Three-year cumulative survival was 47.4% for the resection and 19.9% for radiotherapy. Kaplan-Meier analysis did not demonstrate a statistically significant difference in disease-specific survival between both groups (p=0.082, CI 95%). Results limited only to colorectal liver metastases showed a statistically significant difference in disease-specific survival (p=0.031, CI 95%).

Conclusions: Results of this study show statistically indifferent overall disease-specific survival of both groups. However, the significant difference in 3-year survival still indicates a predominant position of surgery in the diagnostic and therapeutic management of patients with liver malignancies. Nevertheless, Cyberknife® radiotherapy may actually represent a viable treatment alternative, particularly in patients unable to undergo surgical resection, although a longer follow-up period is necessary to obtain more robust results.

Keywords:

liver – radiotherapy – image-guided – liver neoplasms

Sources

  1. Lawrence PF, Bell RM, Dayton MT. Essentials of general surgery. 5th ed. Lippincott Williams & Wilkins 2012. ISBN 978-078-178-495−5.

  2. Ladislav D, Mužík J, Kubásek M, et al. Epidemiologie zhoubných nádorů v České republice [e-publish]. Masarykova univerzita 2005. Available from: www.svod.cz.

  3. Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: A report from the second international consensus conference held in Morioka. Ann Surg. 2015;261:619–29 doi:10.1097/SLA.0000000000001184.

  4. Tsim NC, Frampton AE, Habib NA, et al. Surgical treatment for liver cancer. World J Gastroenterol. 2010;16:927–33. doi:10.3748/WJG.V16.I8.927.

  5. Ananthakrishnan A, Gogineni V, Saeian K. Epidemiology of primary and secondary liver cancers. Semin Intervent Radiol. 2006;23:47–63. doi:10.1055/s-2006-939841.

  6. Mazzaferro V, Regalia E, Doci R, Andreola S, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–700. doi:10.1056/NEJM199603143341104.

  7. Ihnát P, Skácelíková E, Tesař M, et al. Stereotactic body radiotherapy using the CyberKnife® system in the treatment of patients with liver metastases: state of the art. Onco Targets Ther. 2018;11:4685–91. doi:10.2147/OTT.S165878.

  8. Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18. doi:10.1097/00000658-199909000-00004.

  9. Kilby W, Maurer CR, Sayeh S, et al. The CyberKnife® robotic radiosurgery system in 2010. Technol Cancer Res Treat. 2014;9:433–52. doi:10.1177/153303461000900502.

  10. Kato H, Yoshida H, Taniguch H, et al. Cyberknife treatment for advanced or terminal stage hepatocellular carcinoma. World J Gastroenterol. 2015;21:13101. doi:10.3748/wjg.v21.i46.13101.

  11. Adler JR, Chang SD, Murphy MJ, et al. The Cyberknife: A frameless robotic system for radiosurgery. Stereotactic and Functional Neurosurgery 1997;69:124–8. doi:10.1159/00009986.3

  12. Dieterich S, Gibbs IC. The CyberKnife in clinical use: Current roles, future expectations. IMRT, IGRT, SBRT. Karger, Basel 2011;43:181–94. doi:10.1159/000322423.

  13. Fukumitsu N, Okumura T, Sakurai H. Radiotherapy for liver cancer. J Gen Fam Med. 2017;18:126–30. doi:10.1002/jgf2.19.

  14. Mayr NA, Brunner TB, Dawson LA, et al. Stereotactic body radiation therapy for hepatocellular carcinoma: Current trends and controversies. Technol Cancer Res Treat. 2018;17: 153303381879021. doi:10.1177/1533033818790217.

  15. Yuan Z, Tian L, Wang P, et al. Comparative research on the efficacy of CyberKnife and surgical excision for Stage I hepatocellular carcinoma. Onco Targets Ther. 2013;6:1527–32. doi:10.2147/OTT.S51452.

  16. Su T-S, Liang P, Liang J, et al. Long-term survival analysis of stereotactic ablative radiotherapy versus liver resection for small hepatocellular carcinoma. Int J Radiat Oncol. 2017;98:639–46. doi:10.1016/j.ijrobp.2017.02.095.

  17. Que J, Kuo HT, Lin LC, et al. Clinical outcomes and prognostic factors of cyberknife stereotactic body radiation therapy for unresectable hepatocellular carcinoma. BMC Cancer 2016;16:1–10. doi:10.1186/s12885-016-2512-x.

  18. Tse RV, Hawkins M, Lockwood G, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. 2008;26:657–64. doi:10.1200/JCO.2007.14.3529.

  19. Han CJ, Lee BH, Choi CW, et al. Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inope­rable hepatocellular carcinoma. J Surg Oncol. 2010;102:209–14. doi:10.1002/jso.21593.

  20. McPartlin A, Swaminath A, Wang R, et al. Long-term outcomes of phase 1 and 2 studies of SBRT for hepatic colorectal metastases. Int J Radiat Oncol Biol Phys. 2017;99:388–95. doi:10.1016/j.ijrobp.2017.04.010.

  21. Berkovic P, Gulyban A, Nguyen PV, et al. Stereotactic robotic body radiotherapy for patients with unresectable hepatic oligorecurrence. Clin Colorectal Cancer 2017;16:349–57. doi:10.1016/j.clcc.2017.03.006.

  22. Peiffert D, Baumann A-S, Marchesi V. Treatment of hepatic metastases of colo­rectal cancer by robotic stereotactic radiation (Cyberknife (R)). J Visc Surg. 2014;151 Suppl: S45-9. doi:10.1016/j.jviscsurg.2014.01.003.

  23. Mahadevan A, Blanck O, Lanciano R, et al. Stereotactic Body Radiotherapy (SBRT) for liver metastasis – clinical outcomes from the international multi-institutional RSSearch® Patient Registry. Radiat Oncol Radiation Oncology 2018;13:1–11. doi:10.1186/s13014-018-0969-2.

  24. Stintzing S, Einem J von, Fueweger C, et al. Long-term survival in patients treated with a robotic radiosurgical device for liver metastases. Cancer Res Treat. 2019;51:187–193. doi:10.4143/crt.2017.594.

  25. Tasleem S, Bolger JC, Kelly ME, et al. The role of liver resection in patients with metastatic breast cancer: a systematic review examining the survival impact. Irish Journal of Medical Science 2018;187:1009–20. doi:10.1007/s11845-018-1746-9.

  26. Ileana E, Greillier L, Moutardier V, et al. Surgical resection of liver non-small cell lung cancer metastasis: A dual weapon? Lung Cancer 2010;70:221–2. doi:10.1016/j.lungcan.2010.08.010.

  27. Ercolani G, Ravaioli M, Luca Grazi G, et al. The role of liver resections for metastases from lung carcinoma. HPB 2006;8: 114–5. doi:10.1080/13651820500471970.

  28. Adam R, Chiche L, Aloia T, et al. Hepatic resection for noncolorectal nonendocrine liver metastases. Trans Meet Am Surg Assoc. 2006;124:189–200. doi:10.1097/01.sla.0000239036.46827.5f.

  29. Thomas RM, Truty MJ, Nogueras-Gonzalez GM, et al. Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg. 2012;16:1696–1704. doi:10.1007/s11605-012-1912-8.

  30. Khan K, Wale A, Brown G, Chau I. Colorectal cancer with liver metastases: Neoadjuvant chemotherapy, surgical resection first or palliation alone? World J Gastroenterol. 2014;20:12391–406. doi:10.3748/wjg.v20.i35.12391.

  31. Grundmann RT. Current state of surgical treatment of liver metastases from colo­rectal cancer. World J Gastrointest Surg. 2011;3:183. doi:10.4240/wjgs.v3.i12.183.

Labels
Surgery Orthopaedics Trauma surgery
Repopulation of decellularized pig scaffolds: Promising approach for liver tissue engineering
Synchronous liver metastases of rectal cancer and the possibility of simultaneous resection
Radiofrequency ablation of colorectal liver metastases
Therapy of liver cysts – experience of the Department of Surgery, University Hospital in Pilsen 2009−2018
Jaterní chirurgie 21. století
Multidisciplinary team in colorectal cancer treatment – analysis of our patients in 2017
Endovascular treatment of aorto-hepatic bypass thrombosis following liver transplantation
Zemřel primář Otomar Rychnovský
Odcházení
Article was published in

Perspectives in Surgery

Issue 10
2019 Issue 10
Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#