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01.10.2014 | Original article

Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

verfasst von: Tae Hyun Kim, M.D., Joong-Won Park, M.D., Yeon-Joo Kim, M.D., Bo Hyun Kim, M.D., Sang Myung Woo, M.D., Sung Ho Moon, M.D., Sang Soo Kim, Ph.D., Woo Jin Lee, M.D., Dae Yong Kim, M.D., Chang-Min Kim, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 10/2014

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Abstract

Purpose

The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC).

Methods and materials

A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) < 1 cm from gastrointestinal structures, received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 (PTV1) and 2 (PTV2), respectively. The 12 patients in the high dose-fractionation (HD) group, with ITV ≥ 1 cm from gastrointestinal structures, received total doses of 66 and 55 Gy in 22 fractions to the PTV1 and PTV2, respectively.

Results

Overall, treatment was well tolerated, with no grade > 3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7 %) than patients in the HD group (p < 0.05 each). The median overall survival (OS) was 25.1 mKonzept ist machbar und sicheronths and the actuarial 2-year local progression-free survival (LPFS), relapse-free survival (RFS), and OS rates were 67.3, 14.7, and 54.7 %, respectively. The HD group tended to show better tumor response (100 vs. 62.2 %, p = 0.039) and 2-year LPFS (85.7 vs. 59 %, p = 0.119), RFS (38.1 vs. 7.3 %, p = 0.063), and OS (83.3 vs. 44.3 %, p = 0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS.

Conclusion

SIB-IMRT is feasible and safe for patients with inoperable HCC.

Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. The Lancet 359:1734–1739CrossRef

Higuchi T, Kikuchi M, Okazaki M (1994) Hepatocellular carcinoma after transcatheter hepatic arterial embolization. A histopathologic study of 84 resected cases. Cancer 73:2259–2267PubMedCrossRef

Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390PubMedCrossRef

Cheng AL, Kang YK, Chen Z et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34PubMedCrossRef

Seong J, Keum KC, Han KH et al (1999) Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 43:393–397PubMedCrossRef

Kim TH, Kim DY, Park JW et al (2006) Three-dimensional conformal radiotherapy of unresectable hepatocellular carcinoma patients for whom transcatheter arterial chemoembolization was ineffective or unsuitable. Am J Clin Oncol 29:568–575PubMedCrossRef

Cheng JC, Chuang VP, Cheng SH et al (2000) Local radiotherapy with or without transcatheter arterial chemoembolization for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 47:435–442PubMedCrossRef

Meng MB, Cui YL, Lu Y et al (2009) Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 92:184–194PubMedCrossRef

Korean Liver Cancer Study G, National Cancer Center K (2009) Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol 15:391–423

10.

Ueno S, Tanabe G, Nuruki K et al (2002) Prognostic performance of the new classification of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res 24:395–403PubMedCrossRef

11.

Okusaka T, Okada S, Ueno H et al (2002) Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features. Cancer 95:1931–1937PubMedCrossRef

12.

Ikeda K, Seki T, Umehara H et al (2007) Clinicopathologic study of small hepatocellular carcinoma with microscopic satellite nodules to determine the extent of tumor ablation by local therapy. Int J Oncol 31:485–491PubMed

13.

Nakazawa T, Kokubu S, Shibuya A et al (2007) Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 188:480–488PubMedCrossRef

14.

Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60PubMedCrossRef

15.

Seong J, Lee IJ, Shim SJ et al (2009) A multicenter retrospective cohort study of practice patterns and clinical outcome on radiotherapy for hepatocellular carcinoma in Korea. Liver Int 29:147–152PubMedCrossRef

16.

Hawkins MA, Dawson LA (2006) Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer 106:1653–1663PubMedCrossRef

17.

Kim YI, Park HC, Lim do H et al (2012) Changes of the liver volume and the Child–Pugh score after high dose hypofractionated radiotherapy in patients with small hepatocellular carcinoma. Radiat Oncol Journal 30:189–196CrossRef

18.

Wang PM, Hsu WC, Chung NN et al (2013) Radiotherapy with volumetric modulated arc therapy for hepatocellular carcinoma patients ineligible for surgery or ablative treatments. Strahlenther Onkol 189:301–307PubMedCrossRef

19.

Gong GZ, Yin Y, Xing LG et al (2012) RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma. Strahlenther Onkol 188:262–268PubMedCrossRef

20.

Yoon H, Oh D, Park HC et al (2013) Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma. Strahlenther Onkol 189:541–546PubMedCrossRef

21.

Klein J, Dawson LA (2013) Hepatocellular carcinoma radiation therapy: review of evidence and future opportunities. Int J Radiat Oncol Biol Phys 87:22–32PubMedCrossRef

22.

Bujold A, Massey CA, Kim JJ et al (2013) Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 31:1631–1639PubMedCrossRef

23.

Mizumoto M, Tokuuye K, Sugahara S et al (2008) Proton beam therapy for hepatocellular carcinoma adjacent to the porta hepatis. Int J Radiat Oncol Biol Phys 71:462–467PubMedCrossRef

24.

Gierga DP, Chen GT, Kung JH et al (2004) Quantification of respiration-induced abdominal tumor motion and its impact on IMRT dose distributions. Int J Radiat Oncol Biol Phys 58:1584–1595PubMedCrossRef

25.

Yu W, Gu K, Yu Z et al (2013) Sorafenib potentiates irradiation effect in hepatocellular carcinoma in vitro and in vivo. Cancer letters 5329:109–117

Titel: Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma
verfasst von: Tae Hyun Kim, M.D.
Joong-Won Park, M.D.
Yeon-Joo Kim, M.D.
Bo Hyun Kim, M.D.
Sang Myung Woo, M.D.
Sung Ho Moon, M.D.
Sang Soo Kim, Ph.D.
Woo Jin Lee, M.D.
Dae Yong Kim, M.D.
Chang-Min Kim, M.D.
Publikationsdatum: 01.10.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 10/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-014-0643-z

Springer Medizin

Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma