Radiation Therapy Target Research Articles

High Tangent Radiation Therapy With Field-in-Field Technique for Breast Cancer.

Purpose:We evaluated whether the field-in-field (FIF) technique improves the homogeneity of the target in high tangent radiation therapy (HTRT).Materials and Methods:This study included 30 patients. In total, 3 HTRT plans were created: 1 with conventional opposed fields (Conv-p), 1 with the FIF technique (FIF-p), and 1 with FIF technique using lung-blocked subfields (FIF-LB-p).Results:The maximum dose of the breast and planning target volume (PTV) was significantly lower for FIF-p and FIF-LB-p than Conv-p. Homogeneity index of PTV was also significantly lower for FIF-p and FIF-LB-p than Conv-p. Homogeneity index of the breast or PTV was significantly better for FIF-p than FIF-LB-p. The volumes of the breast or the PTV receiving 95% and 90% of the prescribed dose were also significantly better for FIF-p, indicating the advantages of FIF-p.Conclusions:The FIF technique was useful in HTRT and improved homogeneity in the target.

Dissect the Dynamic Molecular Circuits of Cell Cycle Control through Network Evolution Model.

The molecular circuits of cell cycle control serve as a key hub to integrate from endogenous and environmental signals into a robust biological decision driving cell growth and division. Dysfunctional cell cycle control is highlighted in a wide spectrum of human cancers. More importantly the mainstay anticancer treatment such as radiation therapy and chemotherapy targets the hallmark of uncontrolled cell proliferation in cancer cells by causing DNA damage, cell cycle arrest, and cell death. Given the functional importance of cell cycle control, the regulatory mechanisms that drive the cell division have been extensively investigated in a huge number of studies by conventional single-gene approaches. However the complexity of cell cycle control renders a significant barrier to understand its function at a network level. In this study, we used mathematical modeling through modern graph theory and differential equation systems. We believe our network evolution model can help us understand the dynamic cell cycle control in tumor evolution and optimizing dosing schedules for radiation therapy and chemotherapy targeting cell cycle.

P2.03a-067 Therapy-Related Leukemia after Lung Cancer Chemotherapy: Topic: Clinical Trials

Therapy-related leukemia defined by the World health Organization 2008 classification scheme of hematolymphoid tumors including therapy-related acute myeloid neoplasms (t-AML), myelodysplastic syndrome (t-MDS). They occur as late complication of cytotoxic chemotherapy, radiation therapy and molecular target agents therapy against primary neoplasms. Recently, for lung cancer chemotherapy, new anti-cancer agent and molecular target agents are increased and more intensification chemotherapy performed. We report that we reviewed t-AML cases who survived from lung cancer and suffered t-AML. We intended for multiple neoplasms 339 cases including hematological malignancy. We reviewed 55 multiple neoplasms including the lung cancer. In 55 cases, second neoplasms that were t-AML cases were 4 cases, t-MDS case was 1 case. All patients were followed up until death or untile December 2015. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. We investigated cytogenetic abnormality, therapy, clinical outcome, prognosis, and cause of death. In 5 cases, 4 cases were diagnosed t-AML, 1 case was t-MDS. 5 of cases were 4 male and 1 female, primaly diagnosis were small cell carcinoma 2 cases, squamous carcinoma adenocarcinoma 3 cases. 1 case, One case (male case) was t-APL, he treated by all-trans retinoic acid and he reached complete response. T-M2 type, she treated by chemotherapy included daunorbicin and Ara-C (DC3-7), she did not achieve complete response. About prognosis, t-APL case, he lived 1 month after complete response, he died by lung cancer, t-AML cases, one female case, she lived 25 months after partial response, she died by t-AML relapse and refractory for salvage CTx. Other 3 cases, 1 case death by t-MDS, 2 cases death by t-AML. As the number of lung cancer survivors increased due to improvement in chemotherapy, clinician must more take attention of therapy-related leukemia and myelodysplastic syndrome by previous treatments.

Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis.

New indications have been found for regional nodal irradiation (RNI) in breast cancer treatment, yet the relationship of RNI and lymphedema risk is uncertain. We sought to determine the association of RNI and lymphedema. We searched MEDLINE, EMBASE, and Scopus for articles in English on humans published from 1995 to 2015, using search terms breast neoplasm, treatment, and morbidity. Two investigators independently selected articles and extracted information, including manuscripts reporting incidence of lymphedema by radiation targets. Meta-analyses, review papers, case-control studies, matched-pair studies, repetitive datasets, and retrospective studies were excluded. A total of 2399 abstracts were identified and 323 corresponding articles reviewed. Twenty-one studies met inclusion criteria. Data were pooled using a random effects mixed model. Network meta-analyses were performed to determine the association of radiation targets alone and radiation targets plus extent of axillary surgery on incidence of lymphedema. The addition of RNI to breast/CW irradiation was associated with an increased incidence of lymphedema (OR 2.85; 95% CI 1.24-6.55). In patients treated with sentinel lymph node biopsy or axillary sampling, there was no association of lymphedema with the addition of RNI to breast/CW irradiation (OR 1.58; 95% CI 0.54-4.66; pooled incidence 5.7 and 4.1%, respectively). Among patients treated with axillary lymph node dissection (ALND), treatment with RNI in addition to breast/CW radiation was associated with a significantly higher risk of lymphedema (OR 2.74; 95% CI 1.38-5.44; pooled incidence 18.2 and 9.4%, respectively). RNI is associated with a significantly higher risk of lymphedema than irradiation of the breast/CW, particularly after ALND.

Simulating the Effect of Spectroscopic MRI as a Metric for Radiation Therapy Planning in Patients with Glioblastoma.

Due to glioblastoma's infiltrative nature, an optimal radiation therapy (RT) plan requires targeting infiltration not identified by anatomical magnetic resonance imaging (MRI). Here, high-resolution, whole-brain spectroscopic MRI (sMRI) is used to describe tumor infiltration alongside anatomical MRI and simulate the degree to which it modifies RT target planning. In 11 patients with glioblastoma, data from preRT sMRI scans were processed to give high-resolution, whole-brain metabolite maps normalized by contralateral white matter. Maps depicting choline to N-Acetylaspartate (Cho/NAA) ratios were registered to contrast-enhanced T1-weighted RT planning MRI for each patient. Volumes depicting metabolic abnormalities (1.5-, 1.75-, and 2.0-fold increases in Cho/NAA ratios) were compared with conventional target volumes and contrast-enhancing tumor at recurrence. sMRI-modified RT plans were generated to evaluate target volume coverage and organ-at-risk dose constraints. Conventional clinical target volumes and Cho/NAA abnormalities identified significantly different regions of microscopic infiltration with substantial Cho/NAA abnormalities falling outside of the conventional 60 Gy isodose line (41.1, 22.2, and 12.7 cm3, respectively). Clinical target volumes using Cho/NAA thresholds exhibited significantly higher coverage of contrast enhancement at recurrence on average (92.4%, 90.5%, and 88.6%, respectively) than conventional plans (82.5%). sMRI-based plans targeting tumor infiltration met planning objectives in all cases with no significant change in target coverage. In 2 cases, the sMRI-modified plan exhibited better coverage of contrast-enhancing tumor at recurrence than the original plan. Integration of the high-resolution, whole-brain sMRI into RT planning is feasible, resulting in RT target volumes that can effectively target tumor infiltration while adhering to conventional constraints.

Impact of Neuroradiology-Based Peer Review on Head and Neck Radiotherapy Target Delineation.

While standard guidelines assist in target delineation for head and neck radiation therapy planning, the complex anatomy, varying patterns of spread, unusual or advanced presentations, and high risk of treatment-related toxicities produce continuous interpretive challenges. In 2007, we instituted weekly treatment planning quality assurance rounds as a joint enterprise of head and neck radiation oncology and neuroradiology. Here we describe its impact on head and neck radiation therapy target delineation. For 7 months, treatment planning quality assurance included 80 cases of definitive (48%) or postoperative (52%) head and neck radiation therapy. The planning CT and associated target volumes were reviewed in comparison with diagnostic imaging studies. Alterations were catalogued. Of the 80 cases, 44 (55%) were altered, and of these, 61% had clinically significant changes resulting in exclusion or inclusion of a distinct area or structure. Reasons for alteration included the following: gross or extant tumor, 26/44 (59%); elective or postoperative coverage, 25/44 (57%); lymph nodes, 13/44 (30%); bone, 7/44 (16%); skull base, 7/44 (16%); normal organs, 5/44 (11%); perineural, 3/44 (7%); distant metastasis, 2/44 (5%); and eye, 1/44 (2%). Gross tumor changes ranged from 0.5% to 133.64%, with a median change in volume of 5.95 mm3 (7.86%). Volumes were more likely to be increased (73%) than decreased (27%). A collaborative approach to head and neck treatment planning quality assurance has an impact. Cases likely to have challenging patterns of infiltrative, intracranial, nodal, orbital, or perineural spread warrant intensive imaging-based review in collaboration with a diagnostic neuroradiologist.

Management of independent motion between multiple targets in lung cancer radiation therapy

PurposeTo quantify interfractional independent motions between multiple primary targets in radiation therapy (RT) of lung cancer and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods and materialsNinety-five on-treatment diagnostic-quality computed tomography (CT) scans acquired for 9 lung cancer patients treated with image-guided RT (IGRT) using a CT-on-rails (CTVision, Siemens) were analyzed. On each on-treatment CT set, contours of the targets (gross tumor volume, clinical target volume, or involved nodes), and organs at risk were generated by populating the planning contours using an autosegmentation tool (ABAS, Elekta) with manual editing. For each patient, an intensity modulated RT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2 Gy per fraction. Three plans were generated and compared for each on-treatment CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes, and segment weights of the original plan to conform to the on-treatment anatomy and a new fully reoptimized plan based on the on-treatment CT. ResultsThe interfractional deviations of the distance between centers of masses of the targets from the planning CTs varied from –1.0 to 0.8 cm with an average –0.09 ± 0.41 cm (1 standard deviation). The average combined CTV receiving at least 100% of the prescribed dose (V100) were 99.0 ± 0.7%, 97.8 ± 2.8%, 99.0 ± 0.6%, and 99.1 ± 0.6%, and the lung V20Gy 928 ± 332 cm3, 944 ± 315 cm3, 917 ± 300 cm3, and 891 ± 295 cm3 for the original, repositioning, adaptive, and reoptimized plans, respectively. Wilcoxon signed-rank tests showed that the adaptive plans were statistically significantly better than the repositioning plans and comparable with the reoptimized plans. ConclusionInterfractional, relative volume changes and independent motions between multiple primary targets during lung cancer RT, which cannot be accounted for by the current IGRT repositioning exist, but can be corrected by the online adaptive replanning method.

Inhibition of Notch and HIF enhances the antitumor effect of radiation in Notch expressing lung cancer.

The Notch receptor plays an important role in various cell fate decisions during development and in cancer. We have previously reported that Notch3 is upregulated by radiation in non-small cell lung cancer (NSCLC) cell lines and that the Notch pathway inhibitor γ secretase inhibitor GSI (gamma-secretase inhibitor), when combined with radiation therapy, significantly suppressed the growth of lung cancer cells. However, little is known about the mechanism of Notch upregulation induced by radiation. Based on reports of Notch expression being activated through the hypoxia inducible factor 1 (HIF-1) under hypoxic conditions, we hypothesized that HIF-1 would be involved in radiation-induced Notch activation in NSCLC. Changes in HIF-1 and Notch expression in two Notch expressing NSCLC cells line after radiation treatment were examined using Western blotting. Notch expression was evaluated after the suppression of HIF-1α by small interfering RNA. The cytotoxic effect of YC-1, a HIF inhibitor, GSI and radiation was examined using the MTT assay in vitro and the xenograft model. We found radiation-induced expression of HIF-1α protein at 2-6h after treatment and upregulated expression of Notch3 protein at 24h after treatment under hypoxic conditions. Specific suppression of HIF-1α expression downregulated the radiation-induced Notch3 activation, suggesting that the Notch pathway is activated though HIF-1α after radiation. An antitumor effect of YC-1 was evident under hypoxic conditions only when there was simultaneous radiation treatment. GSI and YC-1 had a synergistic antitumor effect in vitro, and the combination of GSI and YC-1 showed the greatest radiosensitivity in vivo. Radiation-induced upregulation of the Notch pathway and HIF-1α protein may be potential therapeutic targets for more effective radiation therapy.

Indications for adjuvant radiation therapy in breast cancer: a review of the evidence and recommendations for clinical practice.

Radiation therapy (RT) plays an important role in the curative management of all stages of breast cancer. The optimal application of adjuvant RT is an area of continuous investigation, and the indications for treatment are refined with each new trial. This article reviews the evidence for adjuvant RT across five distinct clinical scenarios, with additional discussion of RT targets, techniques, and doses where appropriate.

Predicting patterns of failure in temporal lobe glioblastoma multiforme: Implications for novel radiation therapy target volume protocols

Predicting patterns of failure in temporal lobe glioblastoma multiforme: Implications for novel radiation therapy target volume protocols

TU-A-201-00: Image Guidance Technologies and Management Strategies

Recent years have seen a widespread proliferation of available in-room image guidance systems for radiation therapy target localization with many centers having multiple in-room options. In this session, available imaging systems for in-room IGRT will be reviewed highlighting the main differences in workflow efficiency, targeting accuracy and image quality as it relates to target visualization. Decision-making strategies for integrating these tools into clinical image guidance protocols that are tailored to specific disease sites like H&N, lung, pelvis, and spine SBRT will be discussed. Learning Objectives: 1. Major system characteristics of a wide range of available in-room imaging systems for IGRT. 2. Advantages / disadvantages of different systems for site-specific IGRT considerations. 3. Concepts of targeting accuracy and time efficiency in designing clinical imaging protocols.

TU-A-201-02: Treatment Site-Specific Considerations for Clinical IGRT

Recent years have seen a widespread proliferation of available in-room image guidance systems for radiation therapy target localization with many centers having multiple in-room options. In this session, available imaging systems for in-room IGRT will be reviewed highlighting the main differences in workflow efficiency, targeting accuracy and image quality as it relates to target visualization. Decision-making strategies for integrating these tools into clinical image guidance protocols that are tailored to specific disease sites like H&N, lung, pelvis, and spine SBRT will be discussed. Learning Objectives: 1.Major system characteristics of a wide range of available in-room imaging systems for IGRT. 2.Advantages / disadvantages of different systems for site-specific IGRT considerations. 3.Concepts of targeting accuracy and time efficiency in designing clinical imaging protocols.

TU-A-201-01: Introduction to In-Room Imaging System Characteristics

Recent years have seen a widespread proliferation of available in-room image guidance systems for radiation therapy target localization with many centers having multiple in-room options. In this session, available imaging systems for in-room IGRT will be reviewed highlighting the main differences in workflow efficiency, targeting accuracy and image quality as it relates to target visualization. Decision-making strategies for integrating these tools into clinical image guidance protocols that are tailored to specific disease sites like H&N, lung, pelvis, and spine SBRT will be discussed. Learning Objectives: 1. Major system characteristics of a wide range of available in-room imaging systems for IGRT. 2. Advantages / disadvantages of different systems for site-specific IGRT considerations. 3. Concepts of targeting accuracy and time efficiency in designing clinical imaging protocols.

SU‐F‐J‐93: Automated Segmentation of High‐Resolution 3D WholeBrain Spectroscopic MRI for Glioblastoma Treatment Planning

Purpose:We report on an automated segmentation algorithm for defining radiation therapy target volumes using spectroscopic MR images (sMRI) acquired at nominal voxel resolution of 100 microliters.Methods:Wholebrain sMRI combining 3D echo‐planar spectroscopic imaging, generalized auto‐calibrating partially‐parallel acquisitions, and elliptical k‐space encoding were conducted on 3T MRI scanner with 32‐channel head coil array creating images. Metabolite maps generated include choline (Cho), creatine (Cr), and N‐acetylaspartate (NAA), as well as Cho/NAA, Cho/Cr, and NAA/Cr ratio maps. Automated segmentation was achieved by concomitantly considering sMRI metabolite maps with standard contrast enhancing (CE) imaging in a pipeline that first uses the water signal for skull stripping. Subsequently, an initial blob of tumor region is identified by searching for regions of FLAIR abnormalities that also display reduced NAA activity using a mean ratio correlation and morphological filters. These regions are used as starting point for a geodesic level‐set refinement that adapts the initial blob to the fine details specific to each metabolite.Results:Accuracy of the segmentation model was tested on a cohort of 12 patients that had sMRI datasets acquired pre, mid and post‐treatment, providing a broad range of enhancement patterns. Compared to classical imaging, where heterogeneity in the tumor appearance and shape across posed a greater challenge to the algorithm, sMRI's regions of abnormal activity were easily detected in the sMRI metabolite maps when combining the detail available in the standard imaging with the local enhancement produced by the metabolites. Results can be imported in the treatment planning, leading in general increase in the target volumes (GTV60) when using sMRI+CE MRI compared to the standard CE MRI alone.Conclusion:Integration of automated segmentation of sMRI metabolite maps into planning is feasible and will likely streamline acceptance of this new acquisition modality in clinical practice.

Delineation of radiation therapy target volumes for patients with postoperative glioblastoma: a review.

Glioblastoma is the most aggressive and lethal primary malignancy of the brain, and radiotherapy (RT) is a fundamental part of its treatment. However, the optimal radiation treatment conditions are still a matter of debate, and there is no clear consensus concerning the inclusion of peritumoral edema in the clinical target volume calculation. Target delineation calculations that use postoperative residual tumor and cavity volumes plus 2 cm margins result in smaller volumes of normal brain receiving high-dose irradiation, compared to calculations that include expanded edema. Smaller RT fields may be more appropriate than larger RT fields, possibly reducing the risk of late neurological deterioration, especially in patients with significant peritumoral edema. This review focuses on the factors influencing target delineation, such as peritumoral edema, failure patterns, and prognostic factors (clinical and pathological characteristics) of patients with glioblastoma. Based on this information, we make three suggestions for radiation oncologists to refer to in daily practice. Further study is necessary to investigate the unresolved problems related to routine clinical application of RT.

Involved-field irradiation in definitive chemoradiotherapy for T4 squamous cell carcinoma of the esophagus.

Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus. Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time. In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. For patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

Delineation of radiation therapy target volumes for cutaneous malignancies involving the ophthalmic nerve (cranial nerve V-1) pathway

PurposeThe ophthalmic nerve (cranial nerve V-1) runs in close proximity to the globe, optic nerve, chiasm, and brain. The purpose of this study was to provide contouring guidance using computed tomography (CT)-identifiable landmarks, based on an analysis of skin cancer patients with V-1 invasion. Methods and materialsRadiation oncology planning CT scans were analyzed for landmarks to guide V-1 target delineation from the skin surface to the trigeminal ganglion. Axial and coronal magnetic resonance imaging (MRI) sequences were fused with the planning CT to confirm soft-tissue findings and identify enhancement related to perineural spread. CT/MRI-based anatomic landmarks were catalogued and described on an atlas. ResultsSoft-tissue and bony landmarks were confirmed as consistently identifiable on CT with assistance from fused MRI. A reference atlas was developed that shows the entirety of the V-1 pathway on consecutive CT slices. ConclusionsInitial delineation of the V-1 pathway can be accomplished using CT-visualized landmarks confirmed on fused MRI. This CT/MRI atlas will assist radiation oncologists in delineation of the V-1 pathway.

A Technique for Generating Volumetric Cine-Magnetic Resonance Imaging

The purpose of this study was to develop a techique to generate on-board volumetric cine-magnetic resonance imaging (VC-MRI) using patient prior images, motion modeling, and on-board 2-dimensional cine MRI. One phase of a 4-dimensional MRI acquired during patient simulation is used as patient prior images. Three major respiratory deformation patterns of the patient are extracted from 4-dimensional MRI based on principal-component analysis. The on-board VC-MRI at any instant is considered as a deformation of the prior MRI. The deformation field is represented as a linear combination of the 3 major deformation patterns. The coefficients of the deformation patterns are solved by the data fidelity constraint using the acquired on-board single 2-dimensional cine MRI. The method was evaluated using both digital extended-cardiac torso (XCAT) simulation of lung cancer patients and MRI data from 4 real liver cancer patients. The accuracy of the estimated VC-MRI was quantitatively evaluated using volume-percent-difference (VPD), center-of-mass-shift (COMS), and target tracking errors. Effects of acquisition orientation, region-of-interest (ROI) selection, patient breathing pattern change, and noise on the estimation accuracy were also evaluated. Image subtraction of ground-truth with estimated on-board VC-MRI shows fewer differences than image subtraction of ground-truth with prior image. Agreement between normalized profiles in the estimated and ground-truth VC-MRI was achieved with less than 6% error for both XCAT and patient data. Among all XCAT scenarios, the VPD between ground-truth and estimated lesion volumes was, on average, 8.43±1.52% and the COMS was, on average, 0.93±0.58mm across all time steps for estimation based on the ROI region in the sagittal cine images. Matching to ROI in the sagittal view achieved better accuracy when there was substantial breathing pattern change. The technique was robust against noise levels up to SNR = 20. Forpatient data, average tracking errors were less than 2mm in all directions for all patients. Preliminary studies demonstrated the feasibility of generating real-time VC-MRI for on-board localization of moving targets in radiation therapy.

Is a modification of the radiotherapeutic target volume necessary after resection of glioblastomas with opening of the ventricles?

Extensive surgical resection of centrally localized, newly diagnosed glioblastoma can lead to opening ventricles and therefore carries a potential risk of spreading tumor cells into the cebrospinal fluid. However, whether ventricle opening consequently implies a greater frequency of distant tumor recurrence after radiation therapy-and, therefore, reduced survival-remains unknown. Therefore, is an adaption of target volumes in radiation therapy necessary to account for a potential tumor cell spread into the ventricle system? The present study assessed the resection statuses of 311 primary-glioblastoma patients who underwent radiation therapy. Overall, in 78 cases (25.1%) the ventricle system was opened during surgical resection. This study assessed the connection between ventricle opening and progression-free survival, overall survival, and distant and multifocal recurrence. OS rates of patients that underwent gross total resection were superior to patients with subtotal resection (p=0.002). PFS (p=0.53) and OS (p=0.18) did not differ due to ventricle opening during surgical resection. However, in a subsample of STR cases increased survival was observed when the ventricle system was opened (16.8 vs. 14.3months; p=0.03). The occurrence of distant (p=0.75) and contralateral recurrence (p=0.87) was not influenced by ventricle opening. Newly diagnosed glioblastoma patients whose ventricle systems were opened during microsurgical resection did not experience decreased survival or show increased likelihoods of distant and contralateral progressions following radiation therapy. In short, patients profit from surgical resections that are as extensive as reasonably possible, even if this entails ventricle opening. Thus, additional inclusion of the ventricles in the radiation therapy target volume after ventricle opening does not seem to be indicated.

Combined percutaneous ethanol injection and mitoxantrone versus radiofrequency ablation in the treatment of hepatocellular carcinoma

New therapeutic choices have been developed for hepatocellular carcinoma, including percutaneous ablation therapy, transarterial chemoembolization, radiation therapy and molecular target therapy. Ablation of liver tumors is currently the main alternative to liver resection. This work aimed at comparing percutaneous combined local injection of ethanol and mitoxantrone versus percutaneous radiofrequency ablation in the treatment of Hepatocellular Carcinoma. This study included 124 patients with hepatocellular carcinoma, they were randomly divided into two groups; group I (64 patients) treated with local injection of ethanol plus mitoxantrone. Group II (60 patients) treated with radiofrequency ablation. Clinical assessment, laboratory evaluation and CT studies were performed to all patients prior to treatment and at 1, 3, 6, and 12 months' post treatment. The percentage of ablation in both groups at 1, 3, 6 and 12 months were 81.3%, 81.3%,76.6 and 71.9% in group I respectively versus 88.3%, 88.3, 85%% and 81.7% in group II respectively with no statistical significant difference between the two groups. Percentage of ablation in small tumors is higher than large tumors in both groups. Side effects and complications are statistically higher in group II than group I. Combination of percutaneous local injection of ethanol and mitoxantrone is comparable to radiofrequency ablation with less frequent complications in the treatment of Hepatocellular Carcinoma when surgical resection or liver transplantation is not amenable or available.