Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy Combined With Transcatheter Arterial Chemoembolization for Locally Advanced Hepatocellular Carcinoma: An Irradiation Dose Escalation Study

Ren, Zhenggang; Zhao, Jianxing; Gu, Ke; Chen, Zheng; Lin, Jun; Xu, Zhi Yong; Hu, Wei; Zhou, Zhen; Liu, Lu Ming; Jiang, Guo Liang

doi:10.1016/j.ijrobp.2009.10.070

Cited by 23 publications

(17 citation statements)

References 20 publications

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“…The requirements for tumor dose coverage were as follows: the PTV had to be covered by the prescription dose, and inhomogeneity had to be less than 10% [18]. The dose constraints for OAR were as follows: the mean dose of normal liver was limited to 23 Gy, and the dose-volume histogram (DVH) of normal liver was within the tolerance area (i.e., V 5 < 86%, V 10 < 68%, V 20 < 49%, V 30 < 28%, and V 40 < 20%) [34]; for the stomach and duodenum, the maximum dose was limited to 45 Gy, and the volume receiving > 25 Gy was limited to < 5 cm 3 [35].…”

Section: Radiotherapy Plan Design Requirementsmentioning

confidence: 99%

“…The homogeneity index (HI) was defined as (2) The CI and HI ranges from 0 to an ideal value of 1 [33]. The mean irradiated dose of normal liver (D mean ), V 5 , V 10 , V 20 , V 30 , and V 40 , where V x represents the percentage of the volume of x Gy in the volume of normal liver [34], and the maximum doses (D max ) of the stomach and duodenum and the irradiated dose received by 5 cm 3 of volume (D 5cm 3 ) were also recorded and compared [35].…”

Section: Planning Evaluationmentioning

confidence: 99%

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RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma

et al. 2012

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Section: Radiotherapy Plan Design Requirementsmentioning

confidence: 99%

Section: Planning Evaluationmentioning

confidence: 99%

RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma

et al. 2012

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“…For the treatment of HCC, a dose–response relationship was reported [13, 31], and further study showed improved outcomes with dose escalation [32, 33]. Ren et al also mentioned that a dose increase up to 62 Gy might be clinically acceptable depending on the tumor volume [34]. …”

Section: Discussionmentioning

confidence: 99%

A dose-volume intercomparison of volumetric-modulated arc therapy, 3D static conformal, and rotational conformal techniques for portal vein tumor thrombus in hepatocellular carcinoma

Ogino

Hosono

Ishii

et al. 2013

Journal of Radiation Research

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We created volumetric-modulated arc therapy (VMAT) plans for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma, and compared the results with those from three-dimensional conformal radiotherapy (3D-CRT) and rotational conformal radiotherapy (R-CRT) plans. CT scan data from 10 consecutive patients with PVTT treated with 3D-CRT between January 2008 and January 2010 were utilized in the analysis. We analyzed the dosimetric properties of the plans for the 10 patients using the three different techniques with three different isocenter doses of 50, 56 and 60 Gy in 2-Gy fractions. The D95, Dmean, homogeneity index and conformity index were compared for the planning target volume (PTV). The Dmean, V20 and V30 were also compared for normal livers. The monitor units (MUs) and the treatment time were also evaluated. The normal liver V30 for VMAT was significantly less than that for 3D-CRT for the prescribed doses of 56 and 60 Gy (P < 0.05). It was also found that the normal liver V30 resulting from 3D-CRT was prohibitively increased when the prescribed dose was increased in two steps. For PTV D95, we found no significant differences between the three techniques for the 50- and 56-Gy prescriptions, or between VMAT and the other techniques for the 60-Gy prescription. The differences in the MUs and treatment times were not statistically significant between VMAT and 3D-CRT. We have demonstrated that VMAT may be a more advantageous technique for dose escalation reaching 60 Gy in the treatment of PVTT due to the reduced normal liver V30.

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“…Despite the lack of randomized controlled trials, radiotherapy is becoming recognized as a potentially curative treatment option (13). Conformal radiotherapy (CRT) for HCC was reported to exert a significant effect (14)(15)(16), as was SBRT (17)(18)(19)(20). However, the number of studies on the application of CRT and SBRT for the treatment of huge HCCs is limited.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: A clinical study

Zhong

Chen

2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) combined with transarterial chemoembolization (TACE) for huge (≥10 cm) hepatocellular carcinomas (HCCs). Between May, 2006 and December, 2012, 72 patients with huge HCCs were treated by SBRT following incomplete TACE. The median total dose of 35.6 Gy was delivered over 12-14 days with a fractional dose of 2.6-3.0 Gy and 6 fractions per week. The patients were classified into those with tumor encapsulation (group A, n=33) and those without tumor encapsulation (group B, n=39). The clinical outcomes of tumor response, overall cumulative survival and toxicities/complications were retrospectively analyzed. Among the 72 patients, CR, PR, SD and PD were achieved in 6 (8.3%), 51 (70.8%), 9 (12.5%) and 6 patients (8.3%), respectively, within a median follow-up of 18 months. The objective response rate was 79.1%. The overall cumulative 1-, 3-and 5-year survival rates and the median survival time were 38, 12 and 3% and 12.2 months, respectively. In group A, the overall cumulative 1-, 3-and 5-year survival rates were 56, 21 and 6%, respectively, with a median survival of 19 months; in group B, the overall cumulative 1-, 3-and 5-year survival rates were 23, 4 and 0%, respectively, with a median survival of 10.8 months (P=0.023). The treatment was well tolerated, with no severe radiation-induced liver disease and no reported > grade 3 toxicity. Tumor encapsulation was found to be a significant prognostic factor for survival. In conclusion, the combination of SBRT and TACE was shown to be a safe and effective treatment option for patients with unresectable huge HCC.

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Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy Combined With Transcatheter Arterial Chemoembolization for Locally Advanced Hepatocellular Carcinoma: An Irradiation Dose Escalation Study

Cited by 23 publications

References 20 publications

RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma

RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma

A dose-volume intercomparison of volumetric-modulated arc therapy, 3D static conformal, and rotational conformal techniques for portal vein tumor thrombus in hepatocellular carcinoma

Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: A clinical study

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