COMBINED LIVER RADIATION AND CHEMOTHERAPY FOR PALLIATION OF HEPATIC METASTASES FROM COLORECTAL-CANCER

Purpose: To report the effects of boost dose radiation on palliation, survival, and toxicity in patients undergoing palliative treatment for hepatic metastases from colorectal cancers and to assess the potentia l benefits of higher doses of radiation to partial liver volumes. Mate rials and Methods: Forty-five patients with hepatic metastases from co lorectal cancers were treated with a course of palliative irradiation, Eligible patients included those with radiographically or histologica lly proven liver metastases. All patients but one received chemotherap y, either pretreatment (one patient) and/or concurrently with radiatio n (43 patients) via intravenous or hepatic intraarterial infusion. Pat ients were divided into two groups based on whether or not boost radia tion was given. Thirty-three of the 45 patients (group 1) received who le-liver irradiation at doses that ranged from 8 to 31 Gy at 2.0 to 3. 0 Gy per fraction (median dose, 21 Gy), The remaining 12 patients (gro up 2) received liver irradiation to 20 to 30 Gy followed by ct boost d ose to the area of dominant disease for a total dose of 33 to 60 Gy, T he extent of liver involvement was similar between the two groups. Pal liation, overall survival, and toxicity were analyzed with respect to radiation dose, Results: There was no increase in acute effects observ ed in treating partial liver volumes to higher doses in conjunction wi th systemic chemotherapy. No cases of radiation-induced hepatitis or n ephritis were documented, Hematologic toxicity (greater than or equal to grade 3) was observed in four patients with thrombocytopenia, three with leukopenia, and two with anemia, Pain was relieved in 71% and he patomegaly in 59% of group 1 patients, as compared with 100% and 89%, respectively, of group 2 patients. Other symptoms such as nausea, feve r, fatigue, and jaundice were palliated in 35% of group 1 and 90% of g roup 2 patients. The median survival time for group 1 patients was 4 m onths (range, 1 week to 26 months), which is consistent with that repo rted in the literature. The median survival time for group 2 patients was 14 months (range, 2 to 32 months) (P = .01), Conclusion: Standard hepatic irradiation followed by boost radiation to partial liver volum es in combination with chemotherapy is well tolerated without signific ant acute/late morbidity. Higher radiation doses to partial liver volu mes offers improved palliative benefit and may prolong survival withou t an increase in morbidity. (C) 1996 by American Society of Oncology.