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Radiation Oncology
Published in: Radiation Oncology 1/2014

Open Access 01-12-2014 | Research

Feasibility of stereotactic body radiation therapy with volumetric modulated arc therapy and high intensity photon beams for hepatocellular carcinoma patients

Authors: Po-Ming Wang, Wei-Chung Hsu, Na-Na Chung, Feng-Ling Chang, Chin-Jyh Jang, Antonella Fogliata, Marta Scorsetti, Luca Cozzi

Published in: Radiation Oncology | Issue 1/2014

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Abstract

Background

To report technical features, early outcome and toxicity of stereotactic body radiation therapy (SBRT) treatments with volumetric modulated arc therapy (RapidArc) for patients with hepatocellular carcinoma (HCC).

Methods

Twenty patients (22 lesions) were prospectively enrolled in a feasibility study. Dose prescription was 50Gy in 10 fractions. Seven patients (35%) were classified as AJCC stage I-II while 13 (65%) were stages III-IV. Eighteen patients (90%) were Child-Pugh stage A, the remaining were stage B. All patients were treated with RapidArc technique with flattening filter free (FFF) photon beams of 10MV from a TrueBeam linear accelerator. Technical, dosimetric and early clinical assessment was performed to characterize treatment and its potential outcome.

Results

Median age was 68 years, median initial tumor volume was 124 cm3 (range: 6–848). Median follow-up time was 7.4 months (range: 3–13). All patients completed treatment without interruption. Mean actuarial overall survival was of 9.6 ± 0.9 months (95%C.L. 7.8-11.4), median survival was not reached; complete response was observed in 8/22 (36.4%) lesions; partial response in 7/22 (31.8%), stable disease in 6/22 (27.3%), 1/22 (4.4%) showed progression. Toxicity was mild with only 1 case of grade 3 RILD and all other types were not greater than grade 2. Concerning dosimetric data, Paddick conformity index was 0.98 ± 0.02; gradient index was 3.82 ± 0.93; V95% to the clinical target volume was 93.6 ± 7.7%. Mean dose to kidneys resulted lower than 3.0Gy; mean dose to stomach 4.5 ± 3.0Gy; D1cm3 to spinal cord was 8.2 ± 4.5Gy; D1% to the esophagus was 10.2 ± 9.7Gy. Average beam on time resulted 0.7 ± 0.2 minutes (range: 0.4-1.4) with the delivery of an average of 4.4 partial arcs (range: 3–6) of those 86% non-coplanar.

Conclusions

Clinical results could suggest to introduce VMAT-RapidArc as an appropriate SBRT technique for patients with HCC in view of a prospective dose escalation trial.
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Metadata
Title
Feasibility of stereotactic body radiation therapy with volumetric modulated arc therapy and high intensity photon beams for hepatocellular carcinoma patients
Authors
Po-Ming Wang
Wei-Chung Hsu
Na-Na Chung
Feng-Ling Chang
Chin-Jyh Jang
Antonella Fogliata
Marta Scorsetti
Luca Cozzi
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-9-18

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