Abstract
PurposeThe analysis was designed to compare dosimetric parameters among 3-D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT) and RapidArc (RA) to identify which can achieve the lowest risk of radiation-induced liver disease (RILD) for hepatocellular carcinoma (HCC).MethodsTwenty patients with HCC were enrolled in this study. Dosimetric values for 3DCRT, IMRT, and RA were calculated for total dose of 50 Gy/25f. The percentage of the normal liver volume receiving >40, >30, >20, >10, and >5 Gy (V40, V30, V20, V10 and V5) were evaluated to determine liver toxicity. V5, V10, V20, V30 and Dmean of liver were compared as predicting parameters for RILD. Other parameters included the conformal index (CI), homogeneity index (HI), and hot spot (V110%) for the planned target volume (PTV) as well as the monitor units (MUs) for plan efficiency, the mean dose (Dmean) for the organs at risk (OARs) and the maximal dose at 1% volume (D1%) for the spinal cord.ResultsThe Dmean of IMRT was higher than 3DCRT (p = 0.045). For V5, there was a significant difference: RA > IMRT >3DCRT (p <0.05). 3DCRT had a lower V10 and higher V20, V30 values for liver than RA (p <0.05). RA and IMRT achieved significantly better CI and lower V110% values than 3DCRT (p <0.05). RA had better HI, lower MUs and shorter delivery time than 3DCRT or IMRT (p <0.05).ConclusionFor right lobe tumors, RapidArc may have the lowest risk of RILD with the lowest V20 and V30 compared with 3DCRT or IMRT. For diameters of tumors >8 cm in our study, the value of Dmean for 3DCRT was lower than IMRT or RapidArc. This may indicate that 3DCRT is more suitable for larger tumors.
Highlights
Hepatocellular carcinoma (HCC) is the third cause of cancer related death following lung and stomach cancer [1]
Cheng et al [5] showed that both Child-Pugh Class B and the presence of hepatitis B virus were associated with the risk of Radiation-induced liver disease (RILD)
Three sets of plans were all designed on the Varian Eclipse version 8.6.23 treatment planning system which was equipped with a Millennium multileaf collimator (MLC) (Varian) with 120 leaves
Summary
Hepatocellular carcinoma (HCC) is the third cause of cancer related death following lung and stomach cancer [1]. Resection and liver transplantation are generally regarded as curative treatments for HCC in the early stage and have shown effective results [2]. A high radiation dose to the liver would give rise to acute and late hepatic toxicity. Radiation-induced liver disease (RILD) is the most severe radiation-induced complication which may result in hepatic failure and death. The occurrence of RILD is associated with Child-Pugh grade, hepatic cirrhosis and the volume of liver receiving radiotherapy (RT). Cheng et al [5] showed that both Child-Pugh Class B and the presence of hepatitis B virus were associated with the risk of RILD. The study of predicting parameters for RILD risks and sparing more normal liver during RT is essential for HCC patients
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