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Open Access Research

Image-based response assessment of liver metastases following stereotactic body radiotherapy with respiratory tracking

Hajer Jarraya1*, Xavier Mirabel2, Sophie Taieb1, Sylvain Dewas2, Emmanuelle Tresch3, Francois Bonodeau1, Antoine Adenis4, Andrew Kramar3, Eric Lartigau2 and Luc Ceugnart1

Author Affiliations

1 Department of Radiology, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France

2 Department of Radiotherapy, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France

3 Department of Methodology and Biostatistics, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France

4 Department of digestive oncology, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France

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Radiation Oncology 2013, 8:24  doi:10.1186/1748-717X-8-24

Published: 30 January 2013

Abstract

Objective

To describe post-CyberKnife® imaging characteristics of liver metastases as an aid in assessing response to treatment, and a novel set of combined criteria (CC) as an alternative to response according to change in size (RECIST).

Subjects and Methods

Imaging data and medical records of 28 patients with 40 liver metastases treated with stereotactic body radiotherapy (SBRT) were reviewed. Tumor size, CT attenuation coefficient, and contrast enhancement of lesions were evaluated up to 2 years post SBRT. Rates of local control, progression-free survival, time to progression, and overall survival according to RECIST and CC were estimated.

Results

Complete response (CR) was 3.6% (95% CI: 0.1–18%) and 18% (95% CI: 6–37%) according to RECIST and combined criteria, respectively. Two progressive diseases and two partial responses according to RECIST were classified as CR by the combined criteria and one stable response according to RECIST was classified as progressive by CC (Stuart-Maxwell test, p = 0.012). The disease control rate was 60.7% (95% CI: 41–78%) by RECIST and 64% (95% CI: 44%–81%) by CC.

Conclusion

Use of response criteria based on change in size alone in the interpretation of liver response to SBRT may be inadequate. We propose a simple algorithm with a combination of criteria to better assess tumor response. Further studies are needed to confirm their validity.

Keywords:
Stereotactic body radiotherapy; Cyberknife; Imaging; Liver metastasis; Response assessment