The palliation of hepatic metastases: Results of the radiation therapy oncology group pilot study

Abstract

From May, 1976, to July, 1978, 20 Radiation Therapy Oncology Group (RTOG) institutions participated in a prospective, uncontrolled, non-randomized pilot study designed to gain information regarding the feasibility of hepatic irradiation for the treatment of symptomatic liver metastases. One hundred-three of 109 patients who entered were included in the present analysis. Eligible patients included those with hepatic metastases from solid, non-hematologic tumors documented by liver scan. Patients with solitary liver metastases received either 3040 rad/19 fractions or 3000 rad/15 fractions followed by an optional 2000 rad/10 fractions boost to residual disease. Those with a solitary hepatic metastasis plus other sites of metastases or with multiple hepatic metastases received 3000 rad/15 fractions, 2560 rad/16 fractions, 2000 rad/10 fractions or 2100 rad/7 fractions. Seventy-four percent completed the planned course of treatment. Nausea and/or vomiting was induced or aggravated in 16%. There were no documented cases of radiation-induced hepatitis, nephritis or pneumonitis. The degree of symptom improvement ranged from 19 % (weakness/fatigue) to 55 % (pain). Improvement of liver function chemistries occurred in 40 % and palpable liver mass was reduced in 49%. Performance status improved in 25% of patients. The overall median survival of patients who died is 11 weeks. The results of this study indicate that rapid courses of whole liver irradiation are well-tolerated with good therapeutic benefit in patients with symptomatic liver metastases. Additional studies are being developed by the RTOG to investigate combined modality approaches for the palliation of patients with hepatic metastases. © 1981.