Hepatic Tumors Treated with SBRT: Analysis of Local Control and Survival

Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tumors: Analysis of Local Control and Survival Outcomes
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
Research Article
Vol. 4(1), pp. 048-056, November, 2020. © www.premierpublishers.org. ISSN: 5907-4449
Journal of Cancer and Clinical Oncology

ElAlfy and Bondiau 49
Preliminary results in HCC have shown the efficacy of
using SBRT as a locally ablative modality for HCC,
specifically in those unfit for other local therapies (Choi BO,
2008; Méndez Romero A, 2006; Tse RV, 2008).
Nevertheless, its effect on survival is seldom reported. We
will present our results for 76 primary or secondary HM
treated with SBRT (Cyberknife) and factors associated
with their early outcomes such as overall survival (OS),
disease free survival (DFS) and local control (LC).
We will present our results for 76 lesions in 59 patients
diagnosed with either primary hepatic malignancies or
metastases to the liver treated with SBRT (Cyberknife) and
factors associated with their early outcomes such as
overall survival (OS), disease free survival (DFS) and LC.
MATERIALS AND METHODS
Patients: Between March 2007 and December 2012,
Medical records were retrospectively reviewed of 59
patients underwent SBRT with real-time tracking for
primary or secondary HM.
The ethics committee has already approved that
retrospective analysis of the liver cancer cases treated by
SBRT.
The selected patients shoould met the inclusion criteria
that were as follows:
1) ECOG performance status ≥2;
2) all the treated lesion were confined to the liver with the
chossen residual normal liver volume to be ≥700 cc;
3) those unfit for other standard local therapy according
to the liver tumor board or refusing to undergo other
local treatment;
4) the selected patients have accepted and signed
informed consent to be treated with SBRT using the
CyberKnife real-time tracking system.
While the Exclusion criteria were as follows :
1) patients with more than 3 liver lesions;
2) those who recieved atypical dose and fractionations
that not applied in our standard etracrainal SBRT
protocal of treatment which is median dose of 47.61
Gy in 3 fractions prescribed to 80 % isodose line.
Treatment was delivered with Cyberknife system. All
patients signed Informed consent before start of treatment.
Patients and treatment characteristics are shown in Table
(1).
Mean age was 67 years (range, 40 – 89 years), 76 lesions
were treated (45 patients with 1, 11 patients with 2 and 3
patients with 3 lesions).
Patients presented for 48 HM, 8 HCC and 3
cholangiocarcinoma (CC).
34 HM were from gastointestinal tract (oesophagus, colon,
rectum, stomach, anal canal and, pancreas) 2 ovary, 6
breast, 1 lung, 2 choroidal melanoma, 1 kidney, 1 thyroid
and, 1 carcinoma of unknown origin.
Performance status (PS) measured according to ECOG
mostly it was 2.Median volume of PTV was 23.726 cm³,
mean PTV volume was 46.574 cm³ (range, 2.030 -
215.398 cm³).
Table (1): Patients and Treatment characteristics:
Total N
(%)
Or
Median
(range)
Hepato-
carcinoma
Hepatic
Metastases
Cholangio-
carcinoma
Sex:
Male 33
(55.9%)
8 (100%) 25 (52.1%) 0 (0%)
Female 26
(44.1%)
0 (0%) 23 (47.9%) 3 (100%)
Age:
< 65
years
26
(44.1%)
2 (25%) 23 (47.9%) 1 (33.3%)
≥ 65
years
33
(55.9%)
6 (75%) 25 (52.1%) 2 (66.7%)
P.S.:
0 11
(18.6%)
0 (0%) 11 (22.9%) 0 (0%)
1 21
(35.6%)
3 (37.5%) 17 (35.4%) 1 (33.3%)
2 27
(45.8%)
5 (62.5%) 20 (41.7%) 2 (66.7%)
Total
Dose
45 (25-
45) Gy
45 (40-45)
Gy
44 (25-45)
Gy
42 (40-45)
Gy
No. of
fraction
3 (3-5) 3 (3-4) 3 (3-5) 3 (3-4)
ISO-
Dose
line for
PTV
80%
(70%-
119%)
80%
(77%-84%)
80%
(70%-
119%)
80.0%
(80%-84%)
No. of
beams
136
(27-281)
141
(97-181)
143
(27 -281)
130
(118-133)
Dose /
fraction
15 (5-15)
Gy/f
15 (10-15)
Gy/f
15 (5-15)
Gy/f
14 (10-15)
Gy/f
Treatment Planning and Delivery:
Outpatients were treated with Cyberknife using Multiplan
V3 treatment planning software and, the Synchrony
Respiratory Tracking System enabling tracking of tumor
movement in real time. Total accuracy is less than 1.5 mm
with Synchrony for mobile targets with treatment accuracy
of 0.3 mm (Hoogeman M et al, 2008).
Four fiducials are implanted close to the target by a
radiologist with a CT scan under local anesthesia before
the planning CT. Median time between fiducial
implantation and start of treatment was 5-10 days.

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.
The dose was prescribed to 80% isodose line (95% of the
PTV receiving the total dose) delivered in a median of 4
days (range, 4 to 8 days).
Patients received median dose of 47.61 Gy in 3 fractions
prescribed to 80 % isodose line.
Dose limitation to normal tissues:
Liver, kidney, lung, and spinal cord were contoured during
the planning process and dose-volume histograms (DVH)
were used to ensure that normal tissue tolerances were
not exceeded.
Dose constraints:
Dose to medullary canal was limited to 22.5 Gy / 0.25 cc
(max 30Gy), for kidney was 18.6 Gy for 66% volume, for
liver was 21 Gy for < 700 cc (Milano MT et al, 2007).
Follow – up:
All patients had contrast - enhanced CT scan of thorax,
abdomen and pelvis at time of treatment, imaging was
repeated at each follow up visit every 3 months in first 2
years then every 6 months in next 5 years then annually
with clinical examination and assessment of toxicity
according to CTCAE-3.
Statistics:
Descriptive statistics were used for categorical variables
(frequency and percentage) and continuous variables
(median and range). We analyzed: age, gender, PS,
primary site, total dose, number of fractions, dose per
fraction, isodose line, number of beams, size of target
lesion, maximum and minimum doses prescribed to the
tumor and received by organs at risk as liver, kidneys,
lungs and spinal cord, immediate tolerance and acute
toxicity.
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.
RESULTS
For all patients the minimum and maximum doses
received by organs at risk were; right kidney (1.02-20.21),
left kidney (0.97-5.27), spinal cord (0.96-4.69), right lung
(0.75-35.89), left lung (1.27-12.9).
Doses received by target volumes are presented in TABLE
(2).
Table (2): Doses received by the target volumes:
Total
Median
(range)
Gy
Hepato-
cellular
carcinoma
Hepatic
metastases
Cholangio
Carcinoma
GTV:
Min. 39.91
(38.59-
50.31)
42.81
(39.37-
45.09)
39.01
(38.59-
47.2)
43.73
(37.53-
50.31)
Max. 54.57
(45.40-
64.28)
50.31
(45.4-
58.12)
55.62
(48- 64.28)
53.59
(47.89-
56.25)
CTV:
Min. 38.97
(38.59-
45.9)
42.48
(31.61-
45.09)
38.72
(38.59-
45.9)
37.53
(36.68-
44.75)
Max. 54.57
(45.4-
64.28)
50.31
(45.4-
58.12)
55.62
(48- 64.28)
53.59
(47.89-
56.25)
PTV:
Min. 35.77
(37.11-
42.33)
37.87
(27.55-
41.71)
35.55
(37.11-
42.33)
33.85
(33.06-
40.68)
Median 47.61
(31.76-
52.15)
49.88
(43.35-
51.59)
47.51
(31.76-
52.15)
46.72
(44.2-
49.84)
Max. 53.57
(45.4-
64.28)
50.31
(45.4-
58.12)
55.55
(48- 64.28)
53.59
(48.09-
56.25)

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 1: Overall Survival (OS)
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 2: Disease Free Survival (DFS)
LC was 75% and 54.1% at 1 and 2 years, respectively (CI
95%: 12.5% to 39 %). (FIGURE 3)
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%
at 1 and 2 years.
Figure 4: Separated Disease-Free Survival percent
(DFS) per each lesion
HM; OS was 83.6% and 57% at 1 and 2 years respectively,
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.
CC; OS was 100% and 50% at 1 and 2 years respectively,
Both DFS (Figure 4) and LC were 50% at 1 year and, 0%
at 2 years.

Factors influencing clinical outcomes:
We performed a univariate and multivariate analysis for all
previously mentioned variables to identify the prognostic
factors influencing OS, DFS and LC
We will describe in details those with the more statistically
significant results which indicated by the p value less than
0.05 that lead to better local control and/or better survival
outcome, we found that:
All patients:
No factor influencing OS, Factor influencing DFS was dose
ranging from 40 - 44 (P= 0.040), LC affected by; number
of beams ≤ 150 (P= 0.019), coverage> 95% for GTV (P=
0.000), CTV (P= 0.000), PTV (P= 0.001), minimum dose >
35 Gy for PTV (P= 0.037).
Hepatocellular carcinoma:
OS affected by; Max dose > 55 Gy for GTV (P= 0.033),
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).
Hepatic metastases:
OS influenced by; Age < 65 years (P= 0.033), Males (P=
0.050), PTV volume < 50 cm3 (P= 0.002), Coverage > 95%
for GTV (P= 0.041). Factors affected DFS were ; Age < 65
years (P= 0.034), Males (P = 0.017), Total dose of 45 Gy
(P= 0.001), Dose per fraction equal to 15 Gy (P= 0.001),
P.S = 2 (P= 0.024), Max dose > 55 Gy for Gtv (P= 0.000),
CTV (P= 0.000), PTV (P= 0.000), coverage > 95% for GTV
(P= 0.048), CTV (P= 0.031), PTV (P= 0.001), minimum
dose > 35 Gy for GTV (P= 0.032), CTV (p= 0.013), LC
affected by; Females (P= 0.013). min dose > 35 Gy for
PTV (P= 0.05).
Cholangiocarcinoma:
OS affected by: Max dose> 55 Gy for GTV (P = 0.033),
CTV (P= 0.024), PTV (P= 0.041); No factor influencing
DFS or LC.
Toxicity:
Treatment was well tolerated and completed without
breaks for total 58 patients with minimal grade 1 or 2 acute
toxicity as Asthenia, Nausea, Moderate colic, Back pain
and only 2% grade 3 esophageal toxicity. All are
mentioned in TABLE (3).
Table (3): Radiotherapy toxicity:
Total
(n = 59)
Lesions p
HCC
(n = 8)
METS
(n = 48)
Cholangio
(n = 3)
Immediate Tolerance and acute Toxicity
Well
tolerated
(No
Toxicity)
57
(96.6%)
8
(100%)
46
(95.8%)
3 (100%) 1.000
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
Moderate
colic
1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
Back pain
relieved
with
analgesic
1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
Minimal
fatigue
1 (1.7%) 0 (0%) 1 (2.1%) 0 (0%) 1.000
DISCUSSION
Results from our retrospective study demonstrate safety
and feasibility of hypofractionated SBRT for treatment of
primary or HM. During treatment; tumors can be
continuously tracked by implanted fiducial markers,
allowing reduction in tumor margins. Treatment was well
tolerated with minimal grade 1 and 2 toxicity and only one
patient developed grade 3 toxicity (2%), this is consistent
with other SBRT series as Carey Sampson et al. (2006)
observed that morbidity of liver irradiation using SBRT was
low independent of dose fractionation scheduled.
Katz et al. (2007) reported limited grade 1–2 acute toxicity
(0–29%), minimal grade 3–4 toxicity (0–5%); Choi et al.
(2008) found no grade 3 toxicity.
While other studies as Hoyer et al. (2006) observed
hepatic failure leading to death, Dawson et al. (2002)
found nineteen (9.4%) of 203 patients had developed
radiation induced liver disease RILD and reported factors
predicting RILD to be mean liver dose, primary liver cancer
and male, therefore our results of low rate of toxicity can
be explained by the use of a new technology with tracking
capabilities.
For all patients;
OS was 81.4% and 53.3% at 1 and 2 years which is
consistent with Erqi liu et al. (2013) they found OS was 81%
and 52% at 1 and 2 years.
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.

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).
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).

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

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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.

Hepatic Tumors Treated with SBRT: Analysis of Local Control and Survival

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