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




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Radiation Oncology

, 9:18

Clinical Radiation Oncology

Abstract

BackgroundTo 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.

MethodsTwenty 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.

ResultsMedian age was 68 years, median initial tumor volume was 124 cm 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; D1cm 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.

ConclusionsClinical results could suggest to introduce VMAT-RapidArc as an appropriate SBRT technique for patients with HCC in view of a prospective dose escalation trial.

KeywordsHepatocelluar carcinoma RapidArc VMAT SBRT Flattening filter free beams Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-18 contains supplementary material, which is available to authorized users.

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