{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T16:56:54Z","timestamp":1756573014245,"version":"3.40.5"},"reference-count":40,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite advances in chemotherapy, curing multiple liver metastases is quite rare. Even when response is obtained, regrowth of the tumors is almost inevitable. We aimed to evaluate the efficacy and adverse events of helical tomotherapy for chemo\u2010refractory multiple liver metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010five patients with chemo\u2010refractory multiple (3\u201010) liver metastases after standard systemic chemotherapy entered the single\u2010institutional prospective study. Liver metastases were the major disease; however, 31 also had uncontrolled primary lesions and\/or other metastases. The prescribed dose was 55\u00a0Gy in 25 fractions. The median planning target volume (PTV) and normal liver volume (NLV) of first treatment were 128\u00a0cm<jats:sup>3<\/jats:sup> and 1175\u00a0cm<jats:sup>3<\/jats:sup>, respectively. The median of V<jats:sub>15Gy<\/jats:sub>, V<jats:sub>30Gy<\/jats:sub>, and mean dose to NLV were 45%, 23%, and 19.4\u00a0Gy, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010two patients (93%) completed the planned treatment. Median survival time (MST) for all patients was 8\u00a0months, and the 1\u2010year survival rate was 29%. The median local control (LC) period was 5\u00a0months and the 6\u2010month control rate of irradiated tumors was 33%. A\u00a0\u226530% decrease in tumor markers was observed in 31%. The most common grade 3 toxicity was lymphocytopenia (40%), followed by fatigue (6%). Radiation\u2010induced liver disease (RILD) was not observed. Pancreatic cancer as the primary tumor, distant metastases outside the liver, low pretreatment neutrophil\u2010to\u2010lymphocyte ratio (NLR), and low pretreatment monocyte\u2010to\u2010lymphocyte ratio (MLR) were associated with poorer prognoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Helical tomotherapy for chemo\u2010refractory multiple liver metastases is a feasible and potentially effective treatment. Incorporating tomotherapy into the first\u2010line treatment in combination with systemic chemotherapy should be considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>CROG 12005.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.2651","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T03:49:33Z","timestamp":1572407373000},"page":"7594-7602","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Helical tomotherapy for chemo\u2010refractory multiple liver metastases"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2667-8923","authenticated-orcid":false,"given":"Taiki","family":"Takaoka","sequence":"first","affiliation":[{"name":"Department of Radiology Nagoya City University Graduate School of Medical Sciences Nagoya 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