Journal Article

Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

Kim, Yeon-Joo, Kim, Sang Soo, Kim, Dae Yong, Kim, Chang-Min, Park, Joong-Won, Kim, Bo Hyun, Lee, Woo Jin, Moon, Sung Ho, Kim, Tae Hyun, Woo, Sang Myung

2014

Overview

Purpose The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC). Methods and materials A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) < 1 cm from gastrointestinal structures, received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 (PTV1) and 2 (PTV2), respectively. The 12 patients in the high dose-fractionation (HD) group, with ITV ≥ 1 cm from gastrointestinal structures, received total doses of 66 and 55 Gy in 22 fractions to the PTV1 and PTV2, respectively. Results Overall, treatment was well tolerated, with no grade > 3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7 %) than patients in the HD group ( p  < 0.05 each). The median overall survival (OS) was 25.1 mKonzept ist machbar und sicheronths and the actuarial 2-year local progression-free survival (LPFS), relapse-free survival (RFS), and OS rates were 67.3, 14.7, and 54.7 %, respectively. The HD group tended to show better tumor response (100 vs. 62.2 %, p  = 0.039) and 2-year LPFS (85.7 vs. 59 %, p  = 0.119), RFS (38.1 vs. 7.3 %, p  = 0.063), and OS (83.3 vs. 44.3 %, p  = 0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS. Conclusion SIB-IMRT is feasible and safe for patients with inoperable HCC.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Carcinoma, Hepatocellular - diagnosis / Carcinoma, Hepatocellular - radiotherapy / Carcinoma, Hepatocellular - surgery / Combined Modality Therapy - methods / Disease-Free Survival / Dose Fractionation / Female / Humans / Liver Neoplasms - diagnosis / Liver Neoplasms - radiotherapy / Liver Neoplasms - surgery / Male / Medicine / Medicine & Public Health / Middle Aged / Oncology / Original Article / Radiotherapy / Radiotherapy, Conformal - methods / Systems Integration / Treatment Outcome