Abstract
BackgroundTo define the clinical target volume (CTV) for radiotherapy in patients with hepatocellular carcinoma (HCC).MethodsA prospective study was conducted to histologically evaluate the presence and the distance of microscopic extension (ME) for resected HCC on the basis of examination of whole-mount preparations of carcinoma tissue sections.ResultsA total of 380 whole-mount slides prepared from tumor samples of 76 patients with HCC were examined. Patients with elevated pretreatment AFP levels exhibited higher risk of ME as compared to those with normal pretreatment AFP levels (93.9% vs. 69.8%, P < 0.01). ME positivity was 16.7% for Grade 1, 79.1% for Grade 2, and 96.3% for Grade 3 tumors (P < 0.01). The mean distance of ME was 0.0 ± 0.1 mm (range 0-0.2 mm) for Grade 1, 0.9 ± 0.9 mm (range 0-4.5 mm) for Grade 2, and 1.9 ± 1.9 mm (range 0-8.0 mm) for Grade 3 tumors (P < 0.01).ConclusionsThe CTV margins for tumor Grades 1, 2, and 3 HCC, are recommended to be 0.2 mm, 4.5 mm, and 8.0 mm beyond the gross tumor margin, respectively, to account for possible ME of the tumors in all patients.
Highlights
To define the clinical target volume (CTV) for radiotherapy in patients with hepatocellular carcinoma (HCC)
The median tumor size measured on enhanced computed tomography (CT) was 5.0 cm in the greatest dimension
microscopic extension (ME) measurement After fixation of the resected specimen in 13% neutral buffered formalin for ≥12 h, transverse sections were obtained with an average thickness of 10 mm, which were completely embedded in paraffin blocks
Summary
To define the clinical target volume (CTV) for radiotherapy in patients with hepatocellular carcinoma (HCC). It is estimated that in 2009, there will be 22,620 new cases of liver cancer and 18,160 related deaths in America [2] It is the third most common cancer and the second leading cause of cancer-related death in China [3,4]. Guidelines for the extent of ME to be included within the radiation volume would be very useful in clinical practice In this prospective study, we histologically evaluated the ME of HCC using whole-mount slides that should allow for a more representative assessment of the ME by increasing the amount of tissue examined compared to routine small histopathologic slides and defined the CTV as precisely as possible
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