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

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Radiation Oncology

, 9:48

Radiation Physics


PurposeThe analysis was designed to compare dosimetric parameters among 3-D conformal radiotherapy 3DCRT, intensity-modulated radiotherapy IMRT and RapidArc RA to identify which can achieve the lowest risk of radiation-induced liver disease RILD for hepatocellular carcinoma HCC.

MethodsTwenty patients with HCC were enrolled in this study. Dosimetric values for 3DCRT, IMRT, and RA were calculated for total dose of 50 Gy-25f. The percentage of the normal liver volume receiving >40, >30, >20, >10, and >5 Gy V40, V30, V20, V10 and V5 were evaluated to determine liver toxicity. V5, V10, V20, V30 and Dmean of liver were compared as predicting parameters for RILD. Other parameters included the conformal index CI, homogeneity index HI, and hot spot V110% for the planned target volume PTV as well as the monitor units MUs for plan efficiency, the mean dose Dmean for the organs at risk OARs and the maximal dose at 1% volume D1% for the spinal cord.

ResultsThe Dmean of IMRT was higher than 3DCRT p = 0.045. For V5, there was a significant difference: RA > IMRT >3DCRT p <0.05. 3DCRT had a lower V10 and higher V20, V30 values for liver than RA p <0.05. RA and IMRT achieved significantly better CI and lower V110% values than 3DCRT p <0.05. RA had better HI, lower MUs and shorter delivery time than 3DCRT or IMRT p <0.05.

ConclusionFor right lobe tumors, RapidArc may have the lowest risk of RILD with the lowest V20 and V30 compared with 3DCRT or IMRT. For diameters of tumors >8 cm in our study, the value of Dmean for 3DCRT was lower than IMRT or RapidArc. This may indicate that 3DCRT is more suitable for larger tumors.

KeywordsHepatocellular carcinoma Radiotherapy Dosimetry Radiation-induced liver disease Liver protection Abbreviations3DCRTThree-dimensional conformal radiation therapy

IMRTIntensity-modulated radiation therapy


HCCHepatocellular carcinoma

OARsOrgans at risk

RILDRadiation-induced liver disease

HBVHepatitis B virus

CIConformity Index

HIHomogeneity index


TACETransarterial chemoembolization

GTVGross tumor volume

PTVPlanning target volume

DVHDose-volume histograms

DRDose rate

MLCMultileaf collimator

MUMonitor units

Vx%Volume receiving x% of the prescribed dose

DmeanDose mean

VtVolume of PTV

VrefVolume enclosed by the prescription dose line

Vtref: Volume of PTV within Vref.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-48 contains supplementary material, which is available to authorized users.

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Author: Dong Chen - Renben Wang - Xiangjiao Meng - Tonghai Liu - Hongjiang Yan - Rui Feng - Shangang Liu - Shumei Jiang - Xiaoqing

Source: https://link.springer.com/

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