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

Česká verzia

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 place of work: Lékařská fakulta, Ostravská univerzita ¹; Chirurgická klinika, Fakultní nemocnice Ostrava ²; Onkologická klinika, Fakultní nemocnice Ostrava ³
Published in the journal: Rozhl. Chir., 2019, roč. 98, č. 10, s. 408-413.
Category: Original articles

Summary

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

Zdroje

Lawrence PF, Bell RM, Dayton MT. Essentials of general surgery. 5th ed. Lippincott Williams & Wilkins 2012. ISBN 978-078-178-495−5.
Ladislav D, Mužík J, Kubásek M, et al. Epidemiologie zhoubných nádorů v České republice [e-publish]. Masarykova univerzita 2005. Available from: www.svod.cz.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
Fukumitsu N, Okumura T, Sakurai H. Radiotherapy for liver cancer. J Gen Fam Med. 2017;18:126–30. doi:10.1002/jgf2.19.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.