High-Dose Radiotherapy with Intensity-Modulated Radiation Therapy for Advanced Hepatocellular Carcinoma

Kang, Min Kyu; Kim, Myung Se; Kim, Sung Kyu; Ye, Gi Won; Lee, Heon Ju; Kim, Tae Nyeun; Eun, Jong Ryul

doi:10.1177/030089161109700608

Cited by 22 publications

(34 citation statements)

References 34 publications

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“…Zhou et al27 found T stage, PVT, radiation dose, and Child-Pugh classification to be significantly associated with overall survival in univariate analysis, and in Cox regression analysis, T stage, radiation dose, and Child-Pugh classification were independent prognostic factor for overall survival. Kang et al21 found significant associations of PVT, Child-Pugh classification, and primary tumor response with overall survival in univariate analysis, and in multivariate analysis, only primary tumor response remained significant. Kim et al19 reported the Cancer of the Liver Italian Program score and primary tumor response were significant prognostic factors for overall survival in univariate analysis, and only primary tumor response in multivariate analysis.…”

Section: Discussionmentioning

confidence: 96%

“…With the advent of IMRT technique, a few studies also reported the primary tumor response rates after IMRT in unresectable HCC. From a study of 27 HCC patients treated with IMRT, Kang et al21 reported an objective response rate of 44.4%. McIntosh et al22 treated 20 HCC patients with helical tomotherapy and concurrent capecitabine, and reported an objective response rate of 56.25%.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

Kong

Hong²,

Choi³

et al. 2013

Gut Liver

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Background/AimsThis study reports treatment outcomes after helical intensity-modulated radiotherapy (IMRT) in unresectable hepatocellular carcinoma (HCC) patients for whom transarterial chemoembolization (TACE) was considered ineffective or unsuitable.MethodsFrom January 2008 to December 2011, 22 unresectable HCC patients received helical IMRT. A daily dose of 1.8 to 4 Gy was delivered at five fractions per week to deliver a total dose of 30 to 60 Gy. The most-prescribed dose fractionation was a total dose of 50 to 57.5 Gy, with a daily dose of 2.3 to 2.5 Gy.ResultsIn the entire group, the objective response rate of the primary tumor was 72.7%. In the eight patients with portal vein thrombosis (PVT), the objective response rate of PVT was 50.0%. Median disease progression-free survival was 11.8 months, and the 1-year disease progression-free survival rate was 40.2%. The median overall survival was 14.4 months, and the 1- and 2-year overall survival rates were 86.4% and 69.1%, respectively. PVT and Child-Pugh classifications were significant prognostic factors for overall survival in multivariate analyses.ConclusionsHelical IMRT in patients with unresectable HCC resulted in high treatment response and survival rates. This study suggests helical IMRT is a practical treatment option for HCC patients in whom TACE is unsuitable or ineffective.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

Kong

Hong²,

Choi³

et al. 2013

Gut Liver

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“…However, there is a considerable probability for the reactivation of HBV in HCC patients that receive chemotherapeutic drugs, which may be a fatal complication and may lead to disruption in treatment schedules (4). With the development of novel radiotherapy as 3-dimensional conformal therapy or stereotactic radiation therapy, the role of radiotherapy has become of increasing importance in the treatment of HCC, particularly for HCC patients with portal vein tumor thrombus (PVTT) or a tumor diameter <10 cm (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Radiation-induced hepatitis B virus reactivation in hepatocellular carcinoma: A case report

et al. 2015

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Abstract. Hepatitis B virus (HBV) reactivation associated with radiotherapy is rare. The present study reports the case of a 46-year-old man that experienced fatal HBV reactivation. The patient suffered from hepatocellular carcinoma (HCC) with portal vein tumor thrombus, which was treated by radiotherapy at a daily fraction of 2 Gy over 5 weeks, up to a total radiation dose of ~50 Gy. The patient presented with fatigue, yellow sclera and abdominal distension ~8 weeks subsequent to the administration of radiotherapy. The liver function tests, including the level of total bilirubin and prothrombin time, suggested acute-on-chronic liver failure. The serum HBV-DNA level had also increased between undetectable levels and 7.2x10 4 copies/ml. Although the present patient with HCC was treated with 0.5 mg/day entecavir for 8 weeks, in addition to radiotherapy, radiation-induced HBV reactivation occurred. The condition of the patient worsened gradually. The present study emphasizes the importance of liver function and HBV-DNA screening and pre-emptive antiviral prophylaxis prior to radiotherapy in patients with HCC. IntroductionHepatitis B virus (HBV) infection is a serious and common global public health problem (1). It is conservatively estimated that >2 billion individuals have been infected with HBV worldwide and 350 million have suffered from chronic HBV infection. In Asia and the majority of Africa, the disease is particularly prevalent and usually acquired perinatally or in childhood (1). In total, 15-40% of the infected patients will develop cirrhosis, liver failure or hepatocellular carcinoma (HCC), which is currently the fifth most frequent cancer and accounts for between 300,000 and 500,000 mortalities per year (2).Curative surgery is currently available for only 10% of patients. Due to the low tolerance of the liver for irradiation, radiotherapy is limited and is therefore not optimal for the treatment of HCC (3). Therefore, chemotherapy has become a main palliative treatment for certain inoperable patients. However, there is a considerable probability for the reactivation of HBV in HCC patients that receive chemotherapeutic drugs, which may be a fatal complication and may lead to disruption in treatment schedules (4). With the development of novel radiotherapy as 3-dimensional conformal therapy or stereotactic radiation therapy, the role of radiotherapy has become of increasing importance in the treatment of HCC, particularly for HCC patients with portal vein tumor thrombus (PVTT) or a tumor diameter <10 cm (3-5).To the best of our knowledge, previous studies have reported the occurrence of chemotherapy-associated reactivation of HBV in the literature (6,7). However, the occurrence of radiotherapy-associated HBV reactivation is rare. Therefore, the present study reports the case of a patient that experienced fatal HBV reactivation during radiotherapy for HCC with portal vein tumor thrombosis (PVTT) formation. Case reportA 46-year-old male patient with a long history as a HBV carrier presented with fatigue, ye...

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“…Recently, IMRT has been used to treat moving tumors, such as, those of lung cancer or HCC [9-12]. McIntosh et al [10] prescribed 50 Gy in 20 fractions to 20 HCC patients using helical tomotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…Jang et al [11] irradiated 40-50 Gy in 10 fractions to intra- and extra-hepatic lesions simultaneously using helical tomotherapy and found that 45% of intrahepatic lesions achieved more than partial response. Kang et al [12] prescribed 50.4 Gy in 28 fractions to 27 HCC patients by linear accelerator based IMRT, and 44% achieved better than partial response.…”

Section: Introductionmentioning

confidence: 99%

The impact of beam angle configuration of intensity-modulated radiotherapy in the hepatocellular carcinoma

et al. 2012

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PurposeThis treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC).Materials and MethodsThe computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72° (Plan I), and beams with a 30° angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared.ResultsDmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans.ConclusionThe IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.

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High-Dose Radiotherapy with Intensity-Modulated Radiation Therapy for Advanced Hepatocellular Carcinoma

Abstract: Radiotherapy with intensity-modulated radiotherapy achieved a good response rate in patients with advanced hepatocellular carcinoma, and patients who had a good response lived longer than patients who did not have a good response.

Cited by 22 publications

References 34 publications

Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

Treatment Outcomes of Helical Intensity-Modulated Radiotherapy for Unresectable Hepatocellular Carcinoma

Radiation-induced hepatitis B virus reactivation in hepatocellular carcinoma: A case report

The impact of beam angle configuration of intensity-modulated radiotherapy in the hepatocellular carcinoma

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