Grade 1-2 upper GI acute toxicity (nausea, vomiting, gastritis, and pain) was noted in 47% and 55% of patients at 1 week and 1 month, respectively. Correspondingly, acute lower GI toxicity (diarrhea, pain) was lower at 12% and 6%. Overall grade 1-2 GI toxicity was seen in 59% of patients at 1 week (pain and nausea being the most Inhibitors,research,lifescience,medical common)
and 61% of patients at 1 month post SBRT (nausea being the most common). Although not reported in the manuscript, acute upper and lower GI toxicity resolved by 3 months post radiosurgery. Table 6 Acute toxicity Liver toxicity In 7 patients (7 sites), the treated volume encompassed a portion of the liver. Based on pre-and post-SBRT serum LFT’ s (AST, ALT, alk phos), only 1 patient (14%) suffered Grade 2 toxicity at 1-week, and 2 patients (29%) experienced grade 2 toxicity at 1-month (Tab 7). No patients suffered grade 1 or grade 3+ liver toxicity at last follow-up. Table 7 Acute liver toxicity Discussion In this retrospective review, we report on the outcome Inhibitors,research,lifescience,medical of patients treated with hypofractionated image-guided Inhibitors,research,lifescience,medical stereotactic body Selleck Crizotinib radiotherapy for oligometastatic and recurrent abdomino-pelvic malignancies at the Emory Clinic. In the 20 patients treated (23 individually
treated sites), with a median follow-up of 6.3 months, local control was 74%. Local failures tended to occur within the treated area (encompassed by Inhibitors,research,lifescience,medical the PTV), and did not indicate “marginal misses.” 30% of the patients on this study did receive post-SBRT systemic chemotherapy, though the majority of these cases were in patients who showed evidence of progression after SBRT. Historically, this local control value is somewhat less Inhibitors,research,lifescience,medical than that expected by cranial radiosurgery (23), (24), although in the majority of cases no other local treatment options were available for the patients in this study. The doses in this study ranged from 15-25 Gy, the majority delivered in a single fraction. These single-fraction treated patients were part of an institutional dose Isotretinoin escalation protocol, while those patients that received
2 or 3 fractions had previously received external beam radiotherapy in the treated area. As toxicity was relatively mild (discussed below), this may indicate room for dose escalation and or investigation of hypofractionation over 2-3 treatments in order to deliver a higher effective dose. A recent phase I study of SBRT for HCC-IHC has been reported, with dose hypofractionation over 6 treatments to 24-54 Gy (mean 36 Gy), with acceptable toxicity (19). Currently there is an ongoing RTOG phase I SBRT study for liver metastases, incorporating 10 fractions (28). Although there has been a recent trend to treat cranial radiosurgery with a frameless setup, the majority of SRS treatments are still performed with a stereotactic head frame.