Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma

Department of Radiation Oncology, Mackay Memorial Hospital, and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Radiation Oncology (Impact Factor: 2.55). 05/2010; 5(1):40. DOI: 10.1186/1748-717X-5-40
Source: PubMed


To compare the differences in dose-volume data among coplanar intensity modulated radiotherapy (IMRT), noncoplanar IMRT, and helical tomotherapy (HT) among patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT).
Nine patients with unresectable HCC and PVT underwent step and shoot coplanar IMRT with intent to deliver 46-54 Gy to the tumor and portal vein. The volume of liver received 30Gy was set to keep less than 30% of whole normal liver (V30<30%). The mean dose to at least one side of kidney was kept below 23 Gy, and 50 Gy as for stomach. The maximum dose was kept below 47 Gy for spinal cord. Several parameters including mean hepatic dose, percent volume of normal liver with radiation dose at X Gy (Vx), uniformity index, conformal index, and doses to organs at risk were evaluated from the dose-volume histogram.
HT provided better uniformity for the planning-target volume dose coverage than both IMRT techniques. The noncoplanar IMRT technique reduces the V10 to normal liver with a statistically significant level as compared to HT. The constraints for the liver in the V30 for coplanar IMRT vs. noncoplanar IMRT vs. HT could be reconsidered as 21% vs. 17% vs. 17%, respectively. When delivering 50 Gy and 60-66 Gy to the tumor bed, the constraints of mean dose to the normal liver could be less than 20 Gy and 25 Gy, respectively.
Noncoplanar IMRT and HT are potential techniques of radiation therapy for HCC patients with PVT. Constraints for the liver in IMRT and HT could be stricter than for 3DCRT.

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    • "SBRT has substantial activity against HCC, with a local control rate of 87% at 1 year.4 Use of helical tomotherapy (HT) for the treatment of HCC with portal vein thrombosis is clinically feasible and has been investigated.5 "
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    ABSTRACT: We report on a 63-year-old man with a history of hepatitis B virus-related hepatocellular carcinoma with a thrombus extending into the inferior vena cava, who received image-guided stereotactic body radiation therapy (SBRT) with helical tomotherapy, followed by sorafenib. A total tumor dose of 48 Gy was delivered by 6 fractions within 2 weeks. The tumor responded dramatically, and the patient tolerated the courses well. Ten days after SBRT, sorafenib (200 mg), at 1.5 tablets twice a day, was prescribed. One week later, grade 2 recall radiation dermatitis subsequently developed in the previous SBRT off-target area. SBRT followed by sorafenib for the treatment of a portal vein thrombosis provided effective results, but the potential risk of enhanced adverse effects between radiation and sorafenib should be considered with caution, especially under a SBRT scheme.
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    • "and the median survival period ranged from 6.7–10.7 months [14–20]. In addition, intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT), and tomotherapy were also employed for treating PVTT [21, 22]. However, to the best of our knowledge, dose-escalation studies using VMAT for PVTT have not been reported. "
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    • "Irradiated doses to the normal liver can be influenced by beam angle in IMRT plans. Hsieh et al. [14] found that a noncoplanar IMRT plan could reduce irradiated dose to the normal liver as compared with a coplanar IMRT plan in HCC patients. Srivastava et al. [15] reported IMRT with beam angles optimized using an algorithm was superior to manual beam angle selection in patients with head and neck and prostate cancer. "
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