Multicentre results of stereotactic body radiotherapy for secondary liver tumours

AbstractBackgroundSurgical resection is the standard treatment for liver metastases, although for the majority of patients this is not possible. Stereotactic body radiotherapy (SBRT) is an alternative local-regional therapy. The purpose of this study was to evaluate the results of SBRT for secondary liver tumours from a combined multicentre database.MethodsVariables from patients treated with SBRT from four Academic Medical Centres were entered into a common database. Local tumour control and 1-year survival rates were calculated.ResultsIn total, 153 patients (91 women) 59±8.4 years old with 363 metastatic liver lesions were treated with SBRT. The underlying primary tumour arose from gastrointestinal (GI), retroperitoneal and from extra-abdominal primaries in 56%, 8% and 36% of patients, respectively. Metastases, with a gross tumour volume (GTV) of 138.5±126.8cm3, were treated with a total radiation dose of 37.5±8.2Gy in 5±3 fractions. The 1-year overall survival was 51% with an overall local control rate of 62% at a mean follow-up of 25.2±5.9 months. A complete tumour response was observed in 32% of patients. Grade 3–5 adverse events were noted in 3% of patients.ConclusionSecondary liver tumours treated with SBRT had a high rate of local control with a low incidence of adverse events

The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: Risk of infection and recurrence

Background/Objective: The aim was to evaluate the risk of infection and hernia recurrence for patients undergoing repair of ventral hernia (VH) with prosthetic mesh during colorectal resection. Methods: A retrospective review was performed of long-term outcomes for 40 patients who underwent mesh repair for VH during bowel resection between 2000 and 2007. Patients with recurrence (R) were compared with others (NR) and univariate and multivariate analysis of factors associated with recurrence and infection were determined. Results: Forty patients (60% male, mean age 61 years) with colorectal cancer, diverticulitis and inflammatory bowel disease underwent repair with non-absorbable mesh. During the course of follow-up medical visits (median follow-up of 3.0 years; 25th percentile, 75th percentile: 1.8 years, 4.6 years), mesh infection rate was 22.5% and hernia recurrence rate 40%. R (n=16) and NR (n=24) had similar age, gender, body mass index, steroid use, smoking history, and drain use. A significantly greater proportion of R had diabetes (p=0.04), larger fascial defect (p=0.02), emergency surgery (p=0.001), and wound infection (p=0.001). On multivariate analysis, duration of follow-up (p=0.001), comorbidity (p=0.02), large defect size (p=0.04), emergency surgery (p=0.001) and development of infection (p=0.001) were the only factors independently associated with recurrence. Conclusions: Use of non-absorbable mesh during colorectal resection should be very selective. Comorbidity, duration of follow-up, emergency operations, size of area covered and infection are independent factors associated with recurrence

The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: Risk of infection and recurrence

The aim was to evaluate the risk of infection and hernia recurrence for patients undergoing repair of ventral hernia (VH) with prosthetic mesh during colorectal resection. A retrospective review was performed of long-term outcomes for 40 patients who underwent mesh repair for VH during bowel resection between 2000 and 2007. Patients with recurrence (R) were compared with others (NR) and univariate and multivariate analysis of factors associated with recurrence and infection were determined. Forty patients (60% male, mean age 61 years) with colorectal cancer, diverticulitis and inflammatory bowel disease underwent repair with non-absorbable mesh. During the course of follow-up medical visits (median follow-up of 3.0 years, 25th percentile, 75th percentile: 1.8 years, 4.6 years), mesh infection rate was 22.5% and hernia recurrence rate 40%. R (n = 16) and NR (n = 24) had similar age, gender, body mass index, steroid use, smoking history, and drain use. A significantly greater proportion of R had diabetes (p = 0.04), larger fascial defect (p = 0.02), emergency surgery (p = 0.001), and wound infection (p = 0.001). On multivariate analysis, duration of follow-up (p = 0.001), comorbidity (p = 0.02), large defect size (p = 0.04), emergency surgery (p = 0.001) and development of infection (p = 0.001) were the only factors independently associated with recurrence. Use of non-absorbable mesh during colorectal resection should be very selective. Comorbidity, duration of follow-up, emergency operations, size of area covered and infection are independent factors associated with recurrence

Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors

Background. An excess of 100 000 individuals are diagnosed with primary liver tumors every year in USA but less than 20% of those patients are amenable to definitive surgical management due to advanced local disease or comorbidities. Local therapies to arrest tumor growth have limited response and have shown no improvement on patient survival. Stereotactic body radiotherapy (SBRT) has emerged as an alternative local ablative therapy. The purpose of this study was to evaluate the tumor response to SBRT in a combined multicenter database. Study design. Patients with advanced hepatocellular carcinoma (HCC, n = 21) or intrahepatic cholangiocarcinoma (ICC, n = 11) treated with SBRT from four Academic Medical Centers were entered into a common database. Statistical analyses were performed for freedom from local progression (FFLP) and patient survival. Results. The overall FFLP for advanced HCC was 63% at a median follow-up of 12.9 months. Median tumor volume decreased from 334.2 to 135 cm3 (p \u3c 0.004). The median time to local progression was 6.3 months. The 1- and 2-years overall survival rates were 87% and 55%, respectively. Patients with ICC had an overall FFLP of 55.5% at a median follow-up of 7.8 months. The median time to local progression was 4.2 months and the six-month and one-year overall survival rates were 75% and 45%, respectively. The incidence of grade 1–2 toxicities, mostly nausea and fatigue, was 39.5%. Grade 3 and 4 toxicities were present in two and one patients, respectively