Superior liver sparing by combined coplanar/noncoplanar volumetric-modulated arc therapy for hepatocellular carcinoma: A planning and feasibility study

Tsai, Yi Chun; Tsai, Chiao-Ling; Hsu, Feng-Ming; Jian-Kuen, Wu; Wu, Chien-Jang; Cheng, Jason Chia‐Hsien

doi:10.1016/j.meddos.2013.04.003

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…[25][26][27][28] Moreover, heart doses were somewhat reduced on cVMAT plans, as compared with c3D-CRT plans, which is possibly beneficial, as shown by other authors, 8 due to the potential reduction of the risk of longterm cardiac disease, an important issue also for WT patients who are exposed to chemotherapy with anthracyclines. In fact, when perform- Despite awareness that IMRT/VMAT can be utilized to spare normal hepatic tissue, [29][30][31] this study initially aimed to ensure the PTV's homogeneous irradiation, liver included, in view of the relatively low doses employed, theoretical risk of intra-abdominal recurrence, and the paucity of data on long-term hepatic toxicity in WT treatment. 32 Liver doses were significantly but not substantially higher with cVMAT versus c3D-CRT plans, but when actively spared, cVMAT-LS plans were able to reduce liver median doses without compromising PTV coverage.…”

Section: Discussionmentioning

confidence: 99%

Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

Chen

Leão

Simoes

et al. 2020

Pediatric Blood & Cancer

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Purpose To present a preliminary clinical experience and a dosimetric comparison of kidney‐sparing volumetric modulated arc therapy (VMAT) with three‐dimensional conformal radiotherapy (3D‐CRT) for whole abdominal irradiation (WAI), in the setting of Wilms tumor (WT) treatment. Materials and methods From a total of 20 consecutive WT cases treated with adjuvant irradiation, seven were submitted to WAI with VMAT. Renal function and survival rates were evaluated, and, for comparison purposes, similar VMAT and 3D‐CRT treatment plans were performed for WAI patients, and differences were dosimetrically evaluated regarding doses to the remaining kidney and other organs at risk and the planning target volume (PTV). Results After a median follow‐up time of 40.8 months (35.3‐52.2), no acute significant intestinal toxicity was observed, and median creatinine clearance was 110.1 and 103.3 mL/min/1.73 m², respectively, before treatment and at last follow‐up for WAI patients (P = 0.128). For comparative plans, maximum and median doses were lower for the remaining kidney with VMAT than with 3D‐CRT. VMAT was associated with better PTV coverage as compared with 3D‐CRT, with superior results for all the evaluated parameters (D95, D2, V100%, V98%, V95%; P = 0.018). Conclusion The use of VMAT technique is associated with lower radiation doses to the remaining kidney and better coverage to the PTV than 3D‐CRT technique for WAI, with preliminary clinical experience showing a favorable toxicity profile. Long‐term results from prospective studies might prove the ability of VMAT to spare renal function in the setting of WT treatment.

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Section: Discussionmentioning

confidence: 99%

Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

Chen

Leão

Simoes

et al. 2020

Pediatric Blood & Cancer

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“…This technique reduces the normal liver dose similar to s-IMRT, although homogenous dose distribution within the tumor slightly deteriorates. In case of VMAT, the use of non-coplanar arcs provides superior liver protection than s-IMRT for HCC located in the left lobe [ 36 ]. Because of the asymmetric shape and eccentric location of the liver, non-coplanar arcs from the right cranial direction may focus more radiation on the left lobe, and threfore reduce the radiation dose to the normal liver.…”

Section: Dosimetric Studiesmentioning

confidence: 99%

Intensity-modulated radiotherapy for hepatocellular carcinoma: dosimetric and clinical results

2017

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Since the introduction of 3-dimensional conformal radiotherapy (3DCRT), new radiotherapy techniques have expanded the indication of radiotherapy for the treatment of hepatocellular carcinoma (HCC), from the hitherto palliative to a now curative-intent purpose. Intensity-modulated radiotherapy (IMRT), currently the most advanced radiotherapy technique, is considered an attractive option for the treatment of HCC, and is more widely applied because it can deliver a higher dose to the tumor than 3DCRT while sparing surrounding normal organs. However, the advantages and potential disadvantages of IMRT for treating HCC have not been fully established. This article deals with three different IMRT techniques, including static IMRT and volumetric modulated arc therapy using conventional multileaf collimator (MLC) mounted linear accelerators, and helical IMRT using binary MLC mounted helical tomotherapy machine. We review dosimetric and clinical studies for these IMRT techniques for the treatment of HCC.

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“…This can be overcome by the use of volumetric modulated arc therapy (VMAT), which has the capability of delivering the treatment faster with less monitor units. In a study by Tsai et al, the combined coplanar and noncoplanar VMAT was able to deliver a fraction of 3-8 Gy in 7.5 minutes (range, 4-9 minutes) [65]. In addition, it significantly improved the conformality, PTV dose, and sparing of normal tissues for left lobe lesions, allowing a dose escalation of 19%.…”

Section: Techniques To Optimize the Dose Distributionmentioning

confidence: 99%

“…In addition, the dose gradient outside the PTV was shown to be significantly better with the use of noncoplanar beam, reducing the ratio of V 50 and V 100 by 22% [67]. Tsai also commented that the use of noncoplanar beam was particularly beneficial for treating left-sided tumour due to the shape of the liver and its location relative to the normal tissues [65]. Nevertheless, the need for couch rotation is associated with larger uncertainties [68], possibly due to longer setup time and unintended displacement caused by sudden abrupt motion of the couch.…”

Section: Techniques To Optimize the Dose Distributionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Liver Cancer: A Review of the Technology

Kong

Velec

2015

Journal of Medical Imaging and Radiation Sciences

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Superior liver sparing by combined coplanar/noncoplanar volumetric-modulated arc therapy for hepatocellular carcinoma: A planning and feasibility study

Cited by 6 publications

References 24 publications

Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

Intensity-modulated radiotherapy for hepatocellular carcinoma: dosimetric and clinical results

Stereotactic Body Radiation Therapy for Liver Cancer: A Review of the Technology

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