Capabilities of stereotactic radiosurgery for patients with liver metastases.

The introduction of innovative technical developments: the three-dimensional planning, using multileaf collimator, simulated by the intensity radiation therapy, improved methods of fixation significantly improved ability of accurate delivering and escalating of doses of ionizing radiation to the selected volume of tissues. This has changed the perception of the role of radiation therapy in the treatment of liver metastases. Foreign authors data suggest the possibility of reaching 95% local control one year after stereotactic radiotherapy, 92% - after two years (and 100% for tumors smaller than 3 cm.) with the development third or higher degree of radiation damage near in 2%. In 2011, after the technical upgrading of Blokhin Cancer center, the method of stereotactic radiosurgery (SBRS) was introduced in clinical practice for the treatment of patients with liver metastases. This method allows to create a high-dose ionizing radiation in metastatic tumor and cause the destruction of the tumor. This is a promising direction in the treatment of metastatic liver cancer significantly expanded the capabilities of the combined treatment. The article provides an overview of the literature on the treatment of liver metastases, and we publish the results of the use of stereotactic radiosurgery at thirty-five patients with liver metastases and clinical case of successful application of this method in patient with significant co-morbidity.

1. Hoyer M., Swaminath A., Bydder S., et al. Radiotherapy for liver metastases: a review of evidence. Int J Radiat Oncol Biol Phys. 2012. V. 82 (3). P. 1047 57.

2. Lax I., Blomgren H., N slund I., et al. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol. 1994. V. 32 P. 677 683.

3. Poston G. J. Surgical strategies for colorectal liver metastases. Surg Oncol 2004. V. 13. P. 125 36.

4. de Haas R. J., Wicherts D. A., Flores E., et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg. 2008. V. 248 (4). P. 626 37.

5. de Jong M. C., Mayo S. C., Pulitano C., et al. Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi institutional analysis. J Gastrointest Surg. 2009. V. 13 (12). P. 2141 51.

6. Potters L., Kavanagh B., Galvin J. M., et al. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2010. V. 76. P. 326 332.

7. Blomgren H., Lax I., N slund I., Svanstr

8. m R. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty one patients. Acta Oncol. 1995. V. 33. P. 861 70.

9. Blomgren H., Lax I., Goranson H., et al. Radiosurgery for tumors in the body: clinical experience using a new method. J Radiosurg. 1998. V. 1. P. 63 74.

10. Gunv n P, Blomgren H, Lax I. Radiosurgery for recurring liver metastases after hepatectomy. Hepatogastroenterology. 2003. V. 50 (53). P. 1201 4.

11. Dawson L. A., McGinn C. J., Normolle D., et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000. V. 18. P. 2210 2218.

12. Dawson L. A., Normolle D., Balter J. M., et al. Analysis of radiationinduced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys. 2002. V. 53 (4). P. 810 821.

13. Herfarth K. K., Debus J., Lohr F., et al. Stereotactic Single Dose Radiation Therapy of Liver Tumors: Results of a Phase I / II Trial. Journal of Clinical Oncology. 2001. V. 19. P. 164 170.

14. Wulf J., Guckenberger M., Haedinger U., et al. Stereotactic radiotherapy of primary liver cancer and hepatic metastases. Acta Oncol. 2006. V. 45 (7). P. 838 47.

15. Hoyer M., Roed H., Hansen A. T., et al. Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol. 2006. V. 45. P. 823 830.

16. Schefter T. E., Kavanagh B. D., Timmerman R. D., et al. A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys. 2005. V. 62. P. 1371 1378.

17. Kavanagh B. D., Schefter T. E., Cardenes H. R., et al. Interim analysis of a prospective phase I / II trial of SBRT for liver metastases. Acta Oncol. 2006. V. 45. P. 848 855.

18. Rusthoven K. E., Kavanagh B. D., Cardenes H., et al. Multi institutional Phase I / II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009. V. 27. P. 1572 1578.

19. van der Pool A. E., Mendez Romero A., Wunderink W., et al. Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg. 2010. V. 97. P. 377 382.

20. Goodman K. A., Wiegner E. A., Maturen K. E., et al. Dose escalation study of single fraction stereotactic body radiotherapy for liver malignancies. Int J Radiat Oncol Biol Phys. 2010. V. 78. P. 486 493.