A comparison of liver protection among 3-D conformal radiotherapy, intensity-modulated radiotherapy and RapidArc for hepatocellular carcinoma

Chen, Dong; Wang, Renben; Meng, Xiangjiao; Liu, Tonghai; Huang, Yan; Feng, Rui; Liu, Shangang; Jiang, Suping; Xu, Ximing; Zhu, Kangshun; Dou, Xuelin

doi:10.1186/1748-717x-9-48

Cited by 30 publications

(21 citation statements)

References 25 publications

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“…Based on dosimetric comparisons in prostate, liver, and stomach tumours [28][29][30] , RapidArc demonstrated both a high conformal index and the advantages of ptv coverage, results that accord with our analysis. Compared with 3D-crt, RapidArc and imrt showed significant improvements in the conformal and homogeneity indices.…”

Section: Discussionsupporting

confidence: 85%

Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

et al. 2016

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Purpose We compared dosimetry and clinical toxicity for 3-dimensional conformal radiotherapy (3D-crt), intensity-modulated radiotherapy (imrt), and RapidArc (Varian Medical Systems, Palo Alto, CA, U.S.A.) in locally advanced pancreatic cancer (lapcc). We hypothesized that the technique with better sparing of organs at risk (oars) and better target dose distributions could lead to decreased clinical toxicity. MethodsThe study analyzed 280 patients with lapcc who had undergone radiotherapy. The dosimetry comparison was performed using 20 of those patients. Dose-volume histograms for the target volume and the oars were compared. The clinical toxicity comparison used the 280 patients who received radiation with 3D-crt, imrt, or RapidArc. ResultsCompared with 3D-crt, RapidArc and imrt both achieved a better conformal index, homogeneity index, V 95% , and V 110% . Compared with 3D-crt or imrt, RapidArc reduced the V 10 , V 20 , and mean dose to duodenum, the V 20 of the right kidney, and the liver mean dose. Compared with 3D-crt, RapidArc reduced the V 35 , and V 45 of duodenum, the mean dose to small bowel, and the V 15 of right kidney. The incidences of grades 3 and 4 diarrhea (p = 0.037) and anorexia (p = 0.042) were lower with RapidArc than with 3D-crt, and the incidences of grades 3 and 4 diarrhea (p = 0.027) were lower with RapidArc than with imrt.Conclusions Compared with 3D-crt or imrt, RapidArc showed better sparing of oars, especially duodenum, small bowel, and right kidney. Also, fewer acute grades 3 and 4 gastrointestinal toxicities were seen with RapidArc than with 3D-crt or imrt. A technique with better sparing of oars and better target dose distributions could result in decreased clinical toxicities during radiation treatment for lapcc.

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Section: Discussionsupporting

confidence: 85%

Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

et al. 2016

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“…Recent work on the dosimetric consequences of PTV margin size confirms that as the PTV margin decreases, accumulated OAR doses decrease, at the expense of an increased risk of target underdosing 29. The re‐planning strategy outlined in this study mitigated this risk of target miss and preserved the OAR dose sparing gains of small‐margin IMRT for the population as a whole.…”

Section: Discussionmentioning

confidence: 55%

Investigation of dosimetric variations of liver radiotherapy using deformable registration of planning CT and cone‐beam CT

Huang

Chen

et al. 2016

J Applied Clin Med Phys

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Many patients with technically unresectable or medically inoperable hepatocellular carcinoma (HCC) had hepatic anatomy variations as a result of interfraction deformation during fractionated radiotherapy. We conducted this retrospective study to investigate interfractional normal liver dosimetric consequences via reconstructing weekly dose in HCC patients. Twenty‐three patients with HCC received conventional fractionated three‐dimensional conformal radiation therapy (3DCRT) were enrolled in this retrospective investigation. Among them, seven patients had been diagnosed of radiation‐induced liver disease (RILD) and the other 16 patients had good prognosis after treatment course. The cone‐beam CT (CBCT) scans were acquired once weekly for each patient throughout the treatment, deformable image registration (DIR) of planning CT (pCT) and CBCT was performed to acquire modified CBCT (mCBCT), and the structural contours were propagated by the DIR. The same plan was applied to mCBCT to perform dose calculation. Weekly dose distribution was displayed on the pCT dose space and compared using dose difference, target coverage, and dose volume histograms. Statistical analysis was performed to identify the significant dosimetric variations. Among the 23 patients, the three weekly normal liver D50 increased by 0.2 Gy, 4.2 Gy, and 4.7 Gy, respectively, for patients with RILD, and 1.0 Gy, 2.7 Gy, and 3.1 Gy, respectively, for patients without RILD. Mean dose to the normal liver (Dmean) increased by 0.5 Gy, 2.6 Gy, and 4.0 Gy, respectively, for patients with RILD, and 0.4 Gy, 3.1 Gy, and 3.4 Gy, respectively, for patients without RILD. Regarding patients with RILD, the average values of the third weekly D50 and Dmean were both over hepatic radiation tolerance, while the values of patients without RILD were below. The dosimetric consequence showed that the liver dose between patients with and without RILD were different relative to the planned dose, and the RILD patients suffered from liver dose over hepatic radiation tolerance. Evaluation of routinely acquired CBCT images during radiation therapy provides biological information on the organs at risk, and dose estimation based on mCBCT could potentially form the basis for personalized response adaptive therapy.

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“…Normal liver receiving a dose of more than 15 Gy (V 15 ) was found to be a parameter capable of predicting the deterioration of hepatic function [15]. Moreover, dosimetric studies have found that for liver tumors larger than 8 cm, IMRT or VMAT delivered a higher mean liver dose than 3DCRT [16]. These ndings highlight the di culties of using photon radiotherapy to treat large liver tumors optimally.…”

Section: Discussionmentioning

confidence: 99%

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

Cheng

Liu

Wang

et al. 2020

Preprint

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Abstract Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy in treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared the clinical outcomes of the two modalities using medical research databases from our medical foundation.Methods We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms.Results A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p=0.032, HR 0.56, 95% CI 0.33-0.96). The median overall survival in the proton group was not reached and that in the photon group was 17.4 months. The biological equivalent dose of radiotherapy was significantly higher in the proton group than in the photon group (median, 96.56 Gray [relative biological effectiveness] vs. 62.5 Gray, p<0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p=0.004).Conclusions Proton radiotherapy could deliver a higher radiation dose than photon radiotherapy without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.

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A comparison of liver protection among 3-D conformal radiotherapy, intensity-modulated radiotherapy and RapidArc for hepatocellular carcinoma

Cited by 30 publications

References 25 publications

Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

Investigation of dosimetric variations of liver radiotherapy using deformable registration of planning CT and cone‐beam CT

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

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