Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients. Early clinical outcome and toxicity profile from a retrospective analysis of 138 patients

Abstract

BackgroundTo report early outcome and toxicity for inoperable patients with hepatocellular carcinoma (HCC) treated with volumetric modulated arc therapy (VMAT).MethodsOne hundred and thirty eight patients were retrospectively analysed. Dose prescription ranged from 45 to 66Gy with conventional fractionation regime. Based on AJCC staging, 88.4% presented stage III or IV. Two-thirds (69.6%) were Child-Pugh stage A, the remaining were stage B. According to Barcelona Clinic Liver Cancer staging, 72.5% of patients were classified as stage C.ResultsMedian age was 66 years, median tumor volume was 516cm3 (28 to 3620cm3). The most patients (83%) were treated with 60Gy. Median follow-up time was 9 months. One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3). Local control was achieved in 94% (of 109 assessable patients), stable disease in 29%, partial response in 53%, complete response in 11%, and progression in 6%. Radiation-induced liver disease was observed in 34 patients (25%). Gastrointestinal grade 3 toxicity was modest with a total of 17 (12.3%) cases for all endpoints.ConclusionsClinical results could suggest to introduce VMAT as an appropriate technique for the patients with HCC.

High Dose-Volume SBRT Following TACE Improves Clinical Outcomes of Patients with Unresectable Hepatocellular Carcinoma

“…Both severe gastrointestinal AE and radiation-induced liver disease (RILD) have been reported after treatment of HCC with volumetric modulated arc therapy [35]. In contrast, neither severe (grade ≥ 3) RILD nor gastrointestinal AE was observed in the present study.…”

Efficacy and Safety of Intensity-Modulated Radiotherapy Following Transarterial Chemoembolization in Patients With Unresectable Hepatocellular Carcinoma

“…Yoon et al 48 reported RILD in 2/65 patients (3.1%) treated with HT and concurrent transarterial chemoinfusion; median survival time (20 months) was similar to the present study. Wang et al 50 described a response rate of 64% in 138 HCC patients treated with VMAT, 34 (25%) of which developed RILD. As HCC is always surrounded by normal liver parenchyma, rotational IMRT modalities may not offer more liver protection than IMRT.…”

Reducing the probability of radiation-induced hepatic toxicity by changing the treatment modality from helical tomotherapy to fixed-beam intensity-modulated radiotherapy

“…Traditionally, it has been shown that 5-10% of patients who receive 30-35 Gy of radiation to the whole liver experience RIHT [ 12 ]. However, several recent studies showed that partial irradiation of the liver with higher doses is possible with the advancement of radiation techniques [ 7 – 11 ]. An effective radiation dose can be delivered within an acceptable range of RIHT.…”

“…In the past, the role of radiotherapy in HCC patients was limited because of the poor tolerance of the whole liver to radiation [ 4 ]. However, with advances in radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy, several studies have been published reporting the clinical outcomes of these therapies [ 2 , 5 – 11 ]. In addition, several clinical and dosimetric parameters have been suggested for predicting the development of radiation-induced hepatic toxicity (RIHT), because the toxicity to the liver is the greatest impediment to improving clinical outcomes [ 4 , 12 – 19 ].…”