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

Chen-Hsi Hsieh,Tsang-En Wang,Chia-Yuan Liu,Yu-Jen Chen,Ming-Jen Chen,Chih-Jen Chen,Ching-Chung Lin,Shee-Chan Lin,Hui-Ju Tien,Hung-Chi Tai,Kuo-Hsin Chen,Yen-Ping Hsieh,David Yc Huang,Ngot-Swan Chong,Pei-Wei Shueng,Li-Ying Wang

doi:10.1186/1748-717x-5-40

Abstract

BackgroundTo 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).MethodsNine 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.ResultsHT 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.ConclusionNoncoplanar 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.

Highlights

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)
There were no significant differences of coverage for clinical target volume (CTV) and planning-target volume (PTV) between three different techniques. (Table 1) The mean score of Conformity index (CI) showed no significant difference between the HT and IMRT planning
Noncoplanar IMRT and HT are compatible with coplanar IMRT in V95 of CTV and PTV. (Table 1) There are no significant differences of CI between HT and both IMRT techniques

Summary

Introduction

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). Comparing 1991 and 2005, liver cancer is one of the three cancers with an increasing death rate, and the fastest growing death rate (27%) in Several modalities, including surgical resection [11], transcatheter arterial chemoembolization (TACE) [12] and arterial infusion chemotherapy [13], percutaneous ethanol injection therapy, microwave coagulation therapy, radiotherapy, and liver transplantation, have been used in treating HCC [14]. Surgical treatment can only be performed on highly selected patients, because there is a potential risk of postoperative liver failure and early disease recurrence. TACE is considered a contraindication for HCC patients with main portal trunk obstruction and indwelling catheters or catheter-related sepsis, which hinder arterial infusion chemotherapy

Objectives

Methods

Results

Conclusion