The purpose of this study is to evaluate the feasibility, efficacy, and toxicity of SBRT for treatment of unresectable hepatic or lung metastases regardless of their primary tumor site for patients with a history of aggressive systemic chemotherapy. Between July 2007 and June 2010, 90 patients were prospectively enrolled in this observational study and treated with the SBRT system for hepatic or pulmonary metastatic lesions. The endpoints of this study were local control, overall survival (OS), disease-free survival (DFS), relapse free-survival, and treatment toxicity. A total of 113 liver and 26 lung metastatic lesions in 52 men (58%) and 38 women (42%) were treated. Median follow-up was 17 months. Median age was 65 years (range, 23-84 years). Primary cancers were 63 GI, three lung, eight breast, four melanoma, three neuro-endocrine tumors, three sarcomas and six other cancers. Median diameter of the lesions was 28 mm (range, 7-110) for liver and 12.5 mm (range, 5-63.5) for lung. Local control rates at 1 and 2 years were 84.5% and 66.1%, respectively. Two-year OS rate was 70% (95% CI: 55-81%). The 1 and 2-year DFS rates were 27% (95% CI: 18-37%) and 10% (95% CI: 4-20%), respectively. Median duration of DFS was 6.7 months (95% CI: 5.1-9.5 months). Two grade 3 toxicities were observed: gastritis in a patient with a hepatic lesion and epidermitis in a patient treated for two different hepatic lesions. No grade 4 toxicity was reported. High-dose SBRT for metastatic lesions is both feasible and effective with high local control rates. Overall survival is comparable with other available techniques. Treatment is well tolerated with very low toxicity. SBRT could represent an interesting treatment option for oligometastatic patients not amenable to surgery, even for patients heavily pre-treated with chemotherapy.

Le carcinome hépatocellulaire survient dans plus de 90 % des cas dans le cadre d’une hépatopathie chronique. Aussi, son diagnostic doit reposer sur le dépistage semestriel échographique qui doit être institué chez ces patients. Le diagnostic positif de carcinome hépatocellulaire repose sur sa vascularisation étudiée sur les séquences dynamiques après injection de produit de contraste en scanner ou en IRM. L’hypervascularisation artérielle suivie d’un lavage lésionnel aux phases portale et/ou tardive dans un contexte de cirrhose permet le diagnostic positif de CHC sans histologie pour les nodules de plus d’un centimètre (recommandations internationales). Tout autre aspect nécessite une ponction-biopsie nodulaire et extranodulaire pour affirmer le diagnostic. Le bilan d’envahissement local, dominé par l’envahissement portal, et le bilan général doivent être associés à l’évaluation de l’hépatopathie sous-jacente pour guider la décision thérapeutique. Les données recueillies doivent s’inscrire dans un compte-rendu le plus standardisé possible, contenant tous les éléments nécessaires à la prise en charge du patient.

Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) has been evaluated in several recent studies. The CyberKnife is a SBRT system that allows for real-time tracking of the tumor. The purpose of this study was to evaluate the prognostic factors for local control and overall survival of this treatment. From July 2007 to November 2011, 75 patients with 96 liver-confined HCC were treated with SBRT. Three to four fiducials were implanted inside the patients' liver before treatment and were used as markers to follow the movement of the lesion due to respiration. Treatment response was scored according to RECIST v1.1. Local control and overall survival were calculated according to the method of Kaplan and Meier. A stepwise multivariate analysis (Cox regression) of prognostic factors was performed for local control and overall survival. There were 67 patients with Child-Turcotte-Pugh (CTP) Class A and 8 patients with CTP Class B. Treatment was administered in three sessions. A total dose of 40 to 45 Gy at the 80% isodose was delivered with a median number of 146 beams. The average follow-up was 10 months (min: 3 - max: 44). The local control rate was 89.8% at 1 and 2 years. Overall survival was 78.5% and 50.4% at 1 and 2 years. A higher αFP level was associated with worse local control (HR = 1.001 ; 95% CI [1.000, 1.002] ; p = 0.0063) while a higher dose was associated with better local control (HR = 0.866; 95% CI [0.753, 0.996] ; p = 0.0441). Child-Pugh score higher than 5 was associated with worse overall survival (HR = 3.413 ; 95%IC [1.235, 9.435) ; p = 0.018). This treatment, while minimally invasive, presents tumoral local control and overall survival rates comparable to other treatments. High αFP level was associated with worse local control, but a higher treatment dose could improve it. Child-Pugh score above 5 was associated with worse overall survival.