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Conclusion
Our favorable survival and toxicity data support the
potential paradigm shift whereby the use of SBRT in
oligorecurrent liver disease could benefit patients with
unresectable or resectable liver metastases. Our study
shows the importance of adequate dose coverage and
proposes a prescription threshold dose of 45Gy on CTV and
43Gy on PTV to at least 95% of both volumes to
significantly improve LC.
PO-0689 clinical target volume in biliary carcinoma: a
systematic review of pathological studies
I. Marinelli
1
, L. Fuccio
2
, A. Guido
3
, A. Farioli
2
, V. Panni
3
,
G. Ercolani
2
, G. Brandi
2
, S. Cammelli
3
, A. Galuppi
3
, G.
Macchia
4
, R. Frakulli
3
, G. MAttiucci
5
, F. Cellini
5
, M.
Buwenge
3
, M. Renzulli
2
, F. Deodato
4
, S. Cilla
4
, V.
Valentini
5
, V. Tombolini
1
, R. Golfieri
2
, A. Morganti
3
1
Policlinico Umberto I, Division of Radiation Oncology,
Rome, Italy
2
S.Orsola-Malpighi University Hospital, Department of
Medical and Surgical Sciences, Bologna, Italy
3
S.Orsola-Malpighi University Hospital, Division of
Radiation Oncology, Bologna, Italy
4
Fondazione Giovanni Paolo II, Division of Radiation
Oncology, Campobasso, Italy
5
Sacro Cuore Catholic University, Division of Radiation
Oncology, Rome, Italy
Purpose or Objective
Radiation therapy is a treatment option in both adjuvant
and advanced biliary tract cancer. However, lymph nodes
target volume delineation guidelines are lacking. Only
generic indications are available but without specific
recommendations for different primary tumor location
(intrahepatic, extrahepatic biliary tract or gallbladder
cancer). The aim of this study was to systematically
analyze available literature data to provide guidelines on
lymph nodes target volume delineation in unresectable
biliary tumor.
Material and Methods
The systematic search of the electronic databases was
performed from 1990 through July 2016. Primary outcome
measure was the rate of lymph node involvement
according to the primary biliary tumor location. Sites with
≥ 5% incidence of nodal metastases were considered in
the clinical target volume for radiotherapy planning.
Results
Thirteen studies were included. The most frequent site of
metastatic lymph nodes in intrahepatic biliary tree
carcinoma was along the hepatoduodenal ligament [38.7%,
95%CI=31.0-47.0%]. Other frequently involved lymph
nodes were the retroportal [61.1%, 95%CI=50.7-70-6%],
the hilar [16.9%, 95%CI=13.2-21.4%] and the nodes along
the common hepatic artery [17.0%, 95%CI=8.2-31.9%].In
extrahepatic biliary tree cancer, the most frequently
involved lymph nodes were along the hepatoduodenal
ligament
[40.3%,
95%CI=32.4-48.8%]
and
the
pericholedochal nodes [42.7%, 95%CI=33.8-52.1%]. Other
commonly involved nodal regions included retroportal
lymph
nodes
[30.9%,
95%CI=23.0-40.1%],
pancreaticoduodenal anterior and posterior nodes [30.1%,
95%CI=12.2-57.1%], paraaortic nodes [15.2%, 95%CI=8.0-
27.0%] and nodes along the common hepatic artery [19.7%,
95%CI=11.8-31.0%]. The most common site of metastases
in gallbladder cancer were the nodes along cystic duct
[23%, 95% CI=16.6-30.8%], the pericholedochal [25.2%,
95%CI=18.6-33.2%] and the retroportal nodes [17.1%, 95%
CI=11.6-24.5%].
Conclusion
Biliary tract cancer has a high propensity for regional
lymphatic metastases. An evidence-based nodal target
definition of biliary tract cancer based on primary tumor
location was proposed.
PO-0690 An initial result of carbon-ion radiotherapy for
metastatic liver tumors.
S. Toyama
1
, H. Suefuji
1
, M. Shinoto
1
, K. Matsumoto
1
, Y.
Shioyama
1
1
Saga Himat Foundation, Ion Beam Therapy Center, Tosu,
Japan
Purpose or Objective
To evaluate an efficacy and a safety of carbon-ion
radiotherapy (C-ion RT) for metastatic liver tumors (MLT).
Material and Methods
We retrospectively analyzed 22 patients with MLT
received the C-ion RT from April 2014 to March 2016. Male
and female was 14 and 8, respectively. The median age at
the treatment was 68 years old (range; 48-91). Regarding
to the primary site, there were 14 patients with colorectal
cancer (CRC) and the remaining 8 patients with the
different malignancies. The median maximum diameter
was 51 mm (range; 10-109). Seventeen patients had a
singular disease and 5 had multiple ones. Out of all the
patients, 17 patients received 60 Gy (RBE) for 4 fractions
in 1 week, and 5 did 60 Gy (RBE) for 12 fractions in 3
weeks; the 12-fraction schedule was chosen when the
tumors were close to the organs at risk: the digestive
tract, the main trunk of the portal vein, the inferior vena
cava, the common bile duct or the skin. The patients were
fixed by thermoplastic fixation devices, and the tumor was
irradiated from multiple directions with a respiratory
synchronization. The overall survival (OS) and the local
control rate (LCR) were calculated by a Kaplan-Meier
method, and the statistical difference was evaluated by a
log-rank test. Adverse events were classified according to
the Common Terminology Criteria for Adverse Events
version 4.0.
Results
The median observation duration was 383 days (range;
131-875), the 1-year OS and LCR were 90% and 79%,
respectively. At the time of this analysis, 19 patients were