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Original article
peer-reviewed

CyberKnife Radiosurgery – Value as an Adjunct to Surgical Treatment of HCC?



Abstract

Introduction

CyberKnife radiosurgery (CK) is an effective tool for the treatment of malignancies. Its greatest potential is in high-dose radiosurgery delivered to targets in organs that move with respiration, e.g., liver tumors. For hepatocellular carcinoma (HCC), however, surgical treatment (resection, transplantation) is most likely to produce long-term survival; for non-resectable tumors, therapies other than radiosurgery are typically recommended. This study evaluated the long-lasting anti-tumor effects of CK combined with surgery in patients with HCC.

Materials and methods 

Eighteen patients (three women, 15 men) were included in this prospective observational study. They received 21 single-fraction CK treatments (26 Gy). Patient characteristics, treatment effects, tumor response (according to the Response Evaluation Criteria In Solid Tumors (RECIST) grading) and survival were measured for a median period of 29 months.

Results

Local tumor control was achieved in 15 patients, with complete and partial remission observed in 10 and five patients, respectively. One patient was treated for two separate lesions in one session, and one received three treatments each separated by two-year intervals; both patients are tumor-free. Two patients showed minimal response, and in one patient local tumor viability could not be excluded by MRI. Nine patients had HCC recurrence, all distant to the treated site. Nine patients died during follow-up, including two with clear relation to tumor progress. Tumor-free survival was 79.4% after one year and 29.8% after three years, and the corresponding overall survival was 84.8% and 66%.

Conclusion 

This study shows the high effectiveness of single-session frameless CyberKnife radiosurgery for treatment of hepatocellular carcinoma and reconfirms previous results of fractioned radiotherapy of HCC. It also demonstrates the potential of radiosurgery to be combined with surgical concepts.



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Original article
peer-reviewed

CyberKnife Radiosurgery – Value as an Adjunct to Surgical Treatment of HCC?


Author Information

Markus Schoenberg

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich

Andrey Khandoga

Surgery, Ludwig Maximilian University of Munich

Sebastian Stintzing

Internal Medicine, Ludwig Maximilian University of Munich

Christoph Trumm

Hospital of the University of Munich

Tobias Simon Schiergens

Surgery, Ludwig Maximilian University of Munich

Martin Angele

Surgery, Ludwig Maximilian University of Munich

Mark Op den Winkel

Surgery, Ludwig Maximilian University of Munich

Jens Werner

Surgery, Ludwig Maximilian University of Munich

Alexander Muacevic Corresponding Author

European CyberKnife Center Munich

Markus Rentsch

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: A. Muacevic received speaker fees from Accuray Inc. . Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: A. Muacevic is co-editor-in-chief of Cureus.com.

Acknowledgements

We thank Dr. Dave Schaal for meticulous linguistic revision of this manuscript.


Original article
peer-reviewed

CyberKnife Radiosurgery – Value as an Adjunct to Surgical Treatment of HCC?


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Original article
peer-reviewed

CyberKnife Radiosurgery – Value as an Adjunct to Surgical Treatment of HCC?

Markus Schoenberg">Markus Schoenberg, Andrey Khandoga">Andrey Khandoga, Sebastian Stintzing">Sebastian Stintzing, Christoph Trumm">Christoph Trumm, Tobias Simon Schiergens">Tobias Simon Schiergens, Martin Angele">Martin Angele, Mark Op den Winkel">Mark Op den Winkel, Jens Werner">Jens Werner, Alexander Muacevic">Alexander Muacevic , Markus Rentsch">Markus Rentsch

  • Author Information
    Markus Schoenberg

    Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich

    Andrey Khandoga

    Surgery, Ludwig Maximilian University of Munich

    Sebastian Stintzing

    Internal Medicine, Ludwig Maximilian University of Munich

    Christoph Trumm

    Hospital of the University of Munich

    Tobias Simon Schiergens

    Surgery, Ludwig Maximilian University of Munich

    Martin Angele

    Surgery, Ludwig Maximilian University of Munich

    Mark Op den Winkel

    Surgery, Ludwig Maximilian University of Munich

    Jens Werner

    Surgery, Ludwig Maximilian University of Munich

    Alexander Muacevic Corresponding Author

    European CyberKnife Center Munich

    Markus Rentsch

    Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: A. Muacevic received speaker fees from Accuray Inc. . Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: A. Muacevic is co-editor-in-chief of Cureus.com.

    Acknowledgements

    We thank Dr. Dave Schaal for meticulous linguistic revision of this manuscript.


    Article Information

    Published: April 28, 2016

    DOI

    10.7759/cureus.591

    Cite this article as:

    Schoenberg M, Khandoga A, Stintzing S, et al. (April 28, 2016) CyberKnife Radiosurgery – Value as an Adjunct to Surgical Treatment of HCC?. Cureus 8(4): e591. doi:10.7759/cureus.591

    Publication history

    Received by Cureus: April 02, 2016
    Peer review began: April 07, 2016
    Peer review concluded: April 21, 2016
    Published: April 28, 2016

    Copyright

    © Copyright 2016
    Schoenberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

CyberKnife radiosurgery (CK) is an effective tool for the treatment of malignancies. Its greatest potential is in high-dose radiosurgery delivered to targets in organs that move with respiration, e.g., liver tumors. For hepatocellular carcinoma (HCC), however, surgical treatment (resection, transplantation) is most likely to produce long-term survival; for non-resectable tumors, therapies other than radiosurgery are typically recommended. This study evaluated the long-lasting anti-tumor effects of CK combined with surgery in patients with HCC.

Materials and methods 

Eighteen patients (three women, 15 men) were included in this prospective observational study. They received 21 single-fraction CK treatments (26 Gy). Patient characteristics, treatment effects, tumor response (according to the Response Evaluation Criteria In Solid Tumors (RECIST) grading) and survival were measured for a median period of 29 months.

Results

Local tumor control was achieved in 15 patients, with complete and partial remission observed in 10 and five patients, respectively. One patient was treated for two separate lesions in one session, and one received three treatments each separated by two-year intervals; both patients are tumor-free. Two patients showed minimal response, and in one patient local tumor viability could not be excluded by MRI. Nine patients had HCC recurrence, all distant to the treated site. Nine patients died during follow-up, including two with clear relation to tumor progress. Tumor-free survival was 79.4% after one year and 29.8% after three years, and the corresponding overall survival was 84.8% and 66%.

Conclusion 

This study shows the high effectiveness of single-session frameless CyberKnife radiosurgery for treatment of hepatocellular carcinoma and reconfirms previous results of fractioned radiotherapy of HCC. It also demonstrates the potential of radiosurgery to be combined with surgical concepts.



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Create a free account to continue reading this article.

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Markus Schoenberg

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich

Andrey Khandoga

Surgery, Ludwig Maximilian University of Munich

Sebastian Stintzing

Internal Medicine, Ludwig Maximilian University of Munich

Christoph Trumm, None

Hospital of the University of Munich

Tobias Simon Schiergens

Surgery, Ludwig Maximilian University of Munich

Martin Angele

Surgery, Ludwig Maximilian University of Munich

Mark Op den Winkel

Surgery, Ludwig Maximilian University of Munich

Jens Werner

Surgery, Ludwig Maximilian University of Munich

Alexander Muacevic, M.D., Professor

European CyberKnife Center Munich

For correspondence:
alexander.muacevic@cureus.com

Markus Rentsch, None

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich

Markus Schoenberg

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich

Andrey Khandoga

Surgery, Ludwig Maximilian University of Munich

Sebastian Stintzing

Internal Medicine, Ludwig Maximilian University of Munich

Christoph Trumm, None

Hospital of the University of Munich

Tobias Simon Schiergens

Surgery, Ludwig Maximilian University of Munich

Martin Angele

Surgery, Ludwig Maximilian University of Munich

Mark Op den Winkel

Surgery, Ludwig Maximilian University of Munich

Jens Werner

Surgery, Ludwig Maximilian University of Munich

Alexander Muacevic, M.D., Professor

European CyberKnife Center Munich

For correspondence:
alexander.muacevic@cureus.com

Markus Rentsch, None

Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich