Abstract
BackgroundTo report technical features, early outcome and toxicity of stereotactic body radiation therapy (SBRT) treatments with volumetric modulated arc therapy (RapidArc) for patients with hepatocellular carcinoma (HCC).MethodsTwenty patients (22 lesions) were prospectively enrolled in a feasibility study. Dose prescription was 50Gy in 10 fractions. Seven patients (35%) were classified as AJCC stage I-II while 13 (65%) were stages III-IV. Eighteen patients (90%) were Child-Pugh stage A, the remaining were stage B. All patients were treated with RapidArc technique with flattening filter free (FFF) photon beams of 10MV from a TrueBeam linear accelerator. Technical, dosimetric and early clinical assessment was performed to characterize treatment and its potential outcome.ResultsMedian age was 68 years, median initial tumor volume was 124 cm3 (range: 6–848). Median follow-up time was 7.4 months (range: 3–13). All patients completed treatment without interruption. Mean actuarial overall survival was of 9.6 ± 0.9 months (95%C.L. 7.8-11.4), median survival was not reached; complete response was observed in 8/22 (36.4%) lesions; partial response in 7/22 (31.8%), stable disease in 6/22 (27.3%), 1/22 (4.4%) showed progression. Toxicity was mild with only 1 case of grade 3 RILD and all other types were not greater than grade 2. Concerning dosimetric data, Paddick conformity index was 0.98 ± 0.02; gradient index was 3.82 ± 0.93; V95% to the clinical target volume was 93.6 ± 7.7%. Mean dose to kidneys resulted lower than 3.0Gy; mean dose to stomach 4.5 ± 3.0Gy; D1cm3 to spinal cord was 8.2 ± 4.5Gy; D1% to the esophagus was 10.2 ± 9.7Gy. Average beam on time resulted 0.7 ± 0.2 minutes (range: 0.4-1.4) with the delivery of an average of 4.4 partial arcs (range: 3–6) of those 86% non-coplanar.ConclusionsClinical results could suggest to introduce VMAT-RapidArc as an appropriate SBRT technique for patients with HCC in view of a prospective dose escalation trial.
Highlights
To report technical features, early outcome and toxicity of stereotactic body radiation therapy (SBRT) treatments with volumetric modulated arc therapy (RapidArc) for patients with hepatocellular carcinoma (HCC)
Conventional radiotherapy was offered to HCC patients in the past but it was limited by severe radiation induced liver disease (RILD) when excessive fractions of the liver were involved in the radiation field [7] and the important relationship between the volume of irradiated normal liver and the toxicity profile [8,9]
Bujold et al [15], from a cohort of 102 patients treated in two sequential trials between 2004 and 2010, showed a 1 year local control of 87% with a clear association of better outcome with higher SBRT doses, the toxicity higher than grade 3 was observed in one third of the patients
Summary
Early outcome and toxicity of stereotactic body radiation therapy (SBRT) treatments with volumetric modulated arc therapy (RapidArc) for patients with hepatocellular carcinoma (HCC). Kwon et al [13] reported about 42 HCC patients treated with a median dose of 33 Gy in 3 fractions and a local control of 72 and 67.5% at 1 and 2 years, respectively. Bujold et al [15], from a cohort of 102 patients treated in two sequential trials between 2004 and 2010, showed a 1 year local control of 87% with a clear association of better outcome with higher SBRT doses, the toxicity higher than grade 3 was observed in one third of the patients (a severe possibly treatment related fatalities were observed as well). Klein and Dawson [16] concluded that SBRT in HCC can have comparable results with other therapies and suggested that it might be offered as an treatment option for early stage HCC patients or patients not eligible to other ablative procedures for any reason
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
