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  • [Transl Cancer Res.] Treatment outcomes of helical tomotherapy for hepatocellular carcinoma in terms of intermediate-dose spillage

    순천향의대 / 배선현*

  • 출처
    Transl Cancer Res.
  • 등재일
    2021 Mar
  • 저널이슈번호
    10(3):1420-1429. doi: 10.21037/tcr-20-2912.
  • 내용

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    Abstract
    Background: Although helical tomotherapy (HT) tends to increase intermediate-dose spillage by increasing of low-dose region, this has not been fully determined in the clinical setting. Therefore, we investigated treatment outcomes of HT for hepatocellular carcinoma (HCC) with respect to intermediate-dose spillage.

    Methods: We retrospectively reviewed 20 HCC patients, who received high-dose radiotherapy (RT) using HT with radical intent between April 2014 and September 2017. In accordance with the Barcelona Clinic Liver Cancer (BCLC) classification, stage was 0 in 7 patients, A in 3 patients, B in 5 patients, and C in 5 patients. Baseline Child-Pugh class was A in 18 patients and B in 2 patients. The median tumor size was 2.5 cm (range, 1-11 cm). Helical intensity-modulated radiotherapy (IMRT) technique was applied in all patients: among these, 13 patients were treated with stereotactic body radiotherapy (SBRT). The median fraction size was 12 Gy (range, 2-15 Gy), and the median total dose was 50 Gy (range, 44-60 Gy). Intermediate-dose spillage was assessed by the Radiation Therapy Oncology Group recommendation from 22 HT planning data, as follows: R50% means the ratio of the 50% prescription isodose volume to the planning target volume (PTV).

    Results: The median follow-up period after HT was 22 months. The local progression-free survival (LPFS) and progression-free survival (PFS) rates were 89% and 59% at 1 year, and 82% and 30% at 2 years, respectively. The overall survival rate was 100% at 1 year and 85% at 2 years, respectively. In terms of intermediate-dose spillage, minor or major deviations were noted in the R50% of 20 HT plans (91%). However, 1 patient (5%) experienced classic radiation-induced liver disease, and severe toxicity ≥ grade 3 was not reported.

    Conclusions: Although HT for HCC tends to increase intermediate-dose spillage, the treatment results were favorable with that reported in other published studies.

     

     

    Affiliations

    Sun Hyun Bae  1 , Kwang Hwan Cho  1 , Young Seok Kim  2 , Sang Gyune Kim  2 , Jeong-Ju Yoo  2 , Jae Myung Lee  3 , Min Hee Lee  3 , Sanghyeok Lim  3 , Jae Hong Jung  4 , Sung Hee Lim  5
    1 Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
    2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
    3 Department of Radiology, Soonchunhyang University College of Medicine, Bucheon, Korea.
    4 Department of General Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
    5 Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

  • 키워드
    Dose constraints; helical tomotherapy (HT); hepatocellular carcinoma (HCC); radiotherapy (RT).
  • 연구소개
    Helical tomotherapy (HT)는 CT와 유사하게 계속해서 회전하면서 방사선이 조사되는 독특한 방사선치료 장비로 종양주위 중간선량이 증가하는 경향성을 보입니다. 본 연구는 종양주위 정상조직에 sharp dose gradient가 중요한 체부정위방사선치료(stereotactic body radiotherapy, SBRT)를 HT로 적용하여 간세포암종 환자를 치료하였을 때, 방사선치료계획선량인자를 분석하여 중간선량의 적절성을 평가하고, 임상적으로 간독성 및 그 외 치료독성이 증가하는지를 알아보고자 하였습니다. 중간선량의 적절성을 평가하기 위해 RTOG 0915 권고사항에 따라 분석하였을 때, 치료계획의 91%에서 R50%의 major or minor deviations이 관찰되었지만, 오직 1명(5%)에서만 classic radiation-induced liver disease가 발생하였고, 그 외 grade 3 이상의 치료독성은 발견되지 않았습니다. 따라서, HT의 방사선조사 특성상 SBRT시 물리학적으로 종양주위 중간선량이 증가하기는 하지만, 이는 임상적으로 유의한 영향을 미치지 않아, 간세포암종 환자에서 HT를 이용한 SBRT는 안전하고 유효한 치료방법임을 보여주었습니다.
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