scholarly journals Comparison of dose distributions when using carbon ion radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis

2019 ◽  
Author(s):  
Shintaro Shiba ◽  
Kei Shibuya ◽  
Motohiro Kawashima ◽  
Naoko Okano ◽  
Takuya Kaminuma ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
High Risk ◽  
Locally Advanced ◽  
Liver Volume ◽  
Intensity Modulated Radiotherapy ◽  
Carbon Ion Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Dose Distributions ◽  
Carbon Ion ◽  
Intensity Modulated

Abstract Background. Studies comparing the dose distributions of carbon ion radiotherapy (C-ion RT) and intensity-modulated radiotherapy (IMRT) in patients with locally advanced hepatocellular carcinoma (LAHCC) are lacking. This study aimed to investigate the dose distributions of these modalities and identify any advantages to using C-ion RT. Methods. Patients with LAHCC who had undergone C-ion RT between June 2010 and November 2018 were retrospectively analyzed. From among 210 patients with hepatocellular carcinoma who received C-ion RT, 10 consecutive patients with LAHCC were included. The dose-volume histogram parameters of clinical plans using C-ion RT at 60 Gy (relative biological effectiveness [RBE]) and simulated plans using IMRT at 60 Gy and 50 Gy were compared. We evaluated the three plans in terms of the following parameters: the percentage of the minimum dose that covered 95% of the target volume (D95); mean liver dose (MLD); and percentage of the normal liver volume that received at least 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy, and 50 Gy. Patients at high risk of developing radiation-induced liver disease (RILD) were those with MLD and V30 of >23 Gy and >28%, respectively. Results. The V5, V10, V20, and MLD were significantly lower in patients who received 60 Gy (RBE) of C-ion RT than in those who received 60 Gy of IMRT, although the D95 values were not significantly different. The V5, V10, and V20 were also significantly lower in patients who received 60 Gy (RBE) of C-ion RT than in those who received 50 Gy of IMRT; moreover the D95 was significantly superior in the former group. The numbers of high-risk patients who developed RILD when administered 60 Gy (RBE) of C-ion RT, 60 Gy of IMRT, and 50 Gy of IMRT were 1, 7, and 6, respectively. Conclusions. C-ion RT exhibits a better dose distribution to the liver than does IMRT when treating patients with LAHCC. C-ion RT made it possible to treat patients with LAHCC who otherwise could not be treated using IMRT because of the high risk of RILD.

scholarly journals Clinical impact of Hypofractionated carbon ion radiotherapy on locally advanced hepatocellular carcinoma

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shintaro Shiba ◽  
Kei Shibuya ◽  
Masahiko Okamoto ◽  
Shohei Okazaki ◽  
Shuichiro Komatsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Locally Advanced ◽  
Clinical Impact ◽  
Carbon Ion Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Carbon Ion

scholarly journals Clinical Impact of Hypofractionated Carbon Ion Radiotherapy on Locally Advanced Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Shintaro Shiba ◽  
Kei Shibuya ◽  
Masahiko Okamoto ◽  
Shohei Okazaki ◽  
Shuichiro Komatsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Vein ◽  
Local Control ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
Carbon Ion Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Clinical Effects ◽  
Carbon Ion ◽  
Major Branch

Abstract Background Hepatocellular carcinoma (HCC) involving a major branch of the portal or hepatic vein is in a locally advanced stage and remains difficult to cure. This study aimed to evaluate the clinical effects of carbon ion radiotherapy (C-ion RT) in locally advanced HCC (LAHCC). Methods Consecutive 11 patients with LAHCC who received C-ion RT were analyzed. The C-ion RT doses of 52.8 Gy (relative biological effectiveness [RBE]) and 60.0 Gy (RBE) were delivered in four fractions for standard cases and the 60.0 Gy dose was delivered in 12 fractions for close-to-gastrointestinal-tract cases. Survival and local control probabilities were calculated using the Kaplan-Meier method. Results The median follow-up duration after C-ion RT was 36.4 months. The median age at the time of registration of C-ion RT was 76 years. The median tumor size was 53 mm. The number of treatment-naïve and recurrent HCC patients was 1 and 10, respectively. Direct invasion of the major branch of the portal vein, hepatic vein, or both the portal and hepatic veins was observed in three, five, and three patients, respectively. The 3-year overall survival, local control, and progression-free survival rates were 64%, 78%, and 18%, respectively. No patient developed radiation-induced liver diseases or grade 3 or higher toxicities of acute and late phases. Conclusions C-ion RT showed favorable clinical outcomes with a high rate of local control and minimal toxicities in LAHCC. Our findings suggest that C-ion RT is a promising multidisciplinary treatment option in LAHCC.

scholarly journals Clinical Impact of Hypofractionated Carbon Ion Radiotherapy on Locally Advanced Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Shintaro Shiba ◽  
Kei Shibuya ◽  
Masahiko Okamoto ◽  
Shohei Okazaki ◽  
Shuichiro Komatsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Vein ◽  
Local Control ◽  
Multidisciplinary Treatment ◽  
Locally Advanced ◽  
Carbon Ion Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Clinical Effects ◽  
Carbon Ion ◽  
Major Branch

Abstract Background: Hepatocellular carcinoma (HCC) involving a major branch of the portal or hepatic vein is in a locally advanced stage and remains difficult to cure. This study aimed to evaluate the clinical effects of carbon ion radiotherapy (C-ion RT) in locally advanced HCC (LAHCC). Methods: The data of 11 consecutive patients with LAHCC who received C-ion RT were analyzed. The C-ion RT doses of 52.8 Gy (relative biological effectiveness [RBE]) and 60.0 Gy (RBE) were delivered in 4 fractions for standard cases, and the 60.0 Gy dose was delivered in 12 fractions for close-to-gastrointestinal-tract cases. Survival and local control probabilities were calculated using the Kaplan-Meier method. Results: The median follow-up duration after C-ion RT was 36.4 months. The median age at the time of registration for C-ion RT was 76 years. The median tumor size was 53 mm. The numbers of treatment-naive and recurrent HCC patients were 1 and 10, respectively. Direct invasion of the major branch of the portal vein, hepatic vein, or both portal and hepatic veins was observed in three, five, and three patients, respectively. The 3-year overall survival, local control, and progression-free survival rates were 64%, 78%, and 18%, respectively. No patient developed radiation-induced liver diseases or grade 3 or higher toxicities in the acute and late phases. Conclusions: C-ion RT showed favorable clinical outcomes with a high rate of local control and minimal toxicities in LAHCC. Our findings suggest that C-ion RT is a promising multidisciplinary treatment option in LAHCC.

scholarly journals Concurrent Definitive Chemoradiation Incorporating Intensity-Modulated Radiotherapy Followed by Adjuvant Chemotherapy in High Risk Locally Advanced Cervical Squamous Cancer: A Phase Ⅱ Study.

2021 ◽  
Author(s):  
Gong-yi ZHANG ◽  
ZHANG Rong ◽  
Ping BAI ◽  
Shu-min LI ◽  
Yuan-yuan ZHANG ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Advanced Cervical Cancer ◽  
Free Survival ◽  
Locally Advanced Cervical Cancer ◽  
Intensity Modulated ◽  
Grade 3

Abstract Background Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage ⅢB-ⅣA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseⅡ study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. Objectives to determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. Study Design: Patients were enrolled if they had biopsy proven stage ⅢA-ⅣA squamous cervical cancer or stage ⅡB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 ~ 50.0Gy at 1.8Gy ~ 2.0Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0–65 Gy at 2.0- 2.6Gy/fraction in 25 fractions. A total dose of 28 ~ 35Gy high-dose- rate brachytherapy was prescribed to point A in 4 ~ 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30mg/m2 was initiated on the first day of radiotherapy for over 1-hour during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m2 was given as a 3-hour infusion on day1, followed by cisplatin 35 mg/m2 with 1-hour infusion on day1-2 (70 mg/m2 in total). Results Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4 ,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5%, 90.3%, and 88.0%, respectively. Four of the patients died of the disease, and the 5-year overall survival was 92.1%. Most of the toxicities reported during concurrent chemo-radiotherapy were mild and transient. The occurrence of hematological toxicities elevated mildly during adjuvant chemotherapy, as 32% (16/50) and 4% (2/50) patients experienced grade 3–4 leukopenia and thrombocytopenia, respectively. Grade 3–4 late toxicities were reported in 3 patients. Conclusions The incorporation of intensity-modulated radiotherapy and adjuvant paclitaxel plus cisplatin chemotherapy were highly effective and well-tolerated in the treatment of high-risk locally advanced cervical cancer. The former yields an improved loco-regional control, whereas distant metastases could be effectively eradicated with mild toxicities when adjuvant regimen was prescribed.

scholarly journals Stereotactic Body Radiotherapy Versus Intensity-Modulated Radiotherapy For Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis

2021 ◽  
Author(s):  
Liqing Li ◽  
Ying Zhou ◽  
Yong Huang ◽  
Ping Liang ◽  
Shixiong Liang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Stereotactic Body Radiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Portal Vein Tumor Thrombosis ◽  
Efficient Treatment ◽  
Tumor Thrombosis ◽  
Intensity Modulated ◽  
Significant Difference

Abstract Background: It is unclear whether robotic stereotactic body radiotherapy (SBRT) is superior to intensity-modulated radiotherapy (IMRT) in advanced hepatocellular carcinoma (HCC). This study aimed to compare the long-term outcomes of SBRT with those of IMRT in HCCs with portal vein tumor thrombosis (PVTT). Methods: We retrospectively evaluated 287 HCC patients with PVTT who underwent radiotherapy between January 2000 and January 2017. Of them, 154 and 133 patients were treated with IMRT and SBRT, respectively. Overall survival (OS), progression-free survival (PFS), intrahepatic control (IC), and local control (LC) were evaluated in univariable and propensity-score matched analyses. Results: After matching, 102 well-paired patients were selected. There was no significant difference in the 6-, 12-, 24-, and 60-month cumulative OS (73.5, 42.9, 23.6, 7.6% vs. 72.4, 45.1, 29.8, 13.2%, P=0.151), PFS (53.9, 29.3, 21.8, 7.5% vs. 54.5, 19.3, 12.0, 9.6%, P=0.744) , IC (61.4, 45.7, 39.0, 26.8% vs. 75.1, 45.8, 35.9, 28.7%, P=0.144), and LC (85.2, 56.5, 52.1, 47.4% vs. 87.4, 65.2, 62.1, 62.1%, P=0.191) between the IMRT and SBRT groups. A biologically effective dose assumed at an a/b ratio of 10 (BED10) of ≥100 Gy was the optimal cutoff for predicting the OS, PFS, IC, and LC in the patients who received SBRT. Conclusions: When high-precision tracking technology is available, SBRT appears to be a safe and more time-efficient treatment, achieving comparable OS, PFS, IC and LC to IMRT for local advanced HCC with PVTT. A BED10≥100 Gy is recommended if tolerated by normal tissue.

scholarly journals Bimodal Radiotherapy with Active Raster-Scanning Carbon Ion Radiotherapy and Intensity-Modulated Radiotherapy in High-Risk Nasopharyngeal Carcinoma Results in Excellent Local Control

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 379 ◽  
Author(s):  
Sati Akbaba ◽  
Thomas Held ◽  
Kristin Lang ◽  
Tobias Forster ◽  
Philippe Federspil ◽  
...  
Keyword(s):  
High Risk ◽  
Nasopharyngeal Carcinoma ◽  
Local Control ◽  
Intensity Modulated Radiotherapy ◽  
Carbon Ion ◽  
Raster Scanning ◽  
Intensity Modulated ◽  
Grade 3 ◽  
Tumor Remission

Background: In this analysis, we aimed to present the first results of carbon ion radiotherapy (CIRT), which is known for its conformal dose distribution and increased biological effectiveness in the treatment of high-risk nasopharyngeal carcinoma (NPC). Methods: We retrospectively analyzed twenty-six consecutive patients who had been treated at our center with CIRT for high-risk NPC between 2009 and 2018. Carbon ion (C12) boost was applied in a bimodal setting combined with intensity-modulated radiotherapy (IMRT) base plan. The median cumulative total dose was 74 Gy (RBE), and patients with inoperable (n = 17, 65%) or incompletely resected (n = 7, 27%) tumors were included in the analysis. Overall, 81% received concomitant chemotherapy (n = 21). Results: The median follow-up time was 40 months (range 10–97 months) for all patients. At the last follow-up, 92% of the patients were still alive. We could identify excellent tumor response with complete tumor remission (CR) in 60% (n = 15/25), partial tumor remission (PR) in 20% (n = 5/25), and stable disease (SD) in 12% (n = 3/25) of the patients according to the RECIST (Response Evaluation Criteria in Solid Tumors) criteria. Despite unfavorable tumor characteristics, only one patient showed a locally in-field recurrence after 56 months (4%) and another patient a locoregional recurrence in the unilateral cervical lymph nodes after 21 months (4%). The 2-year local control (LC), distant progression-free survival (DPFS), and overall survival (OS) were 95%, 93%, and 100% and the estimated 5-year LC, DPFS, and OS were 90%, 86%, and 86%, respectively. Overall, treatment was tolerated well with 20% acute and 16% chronic grade 3 side effects. No toxicity greater than grade 3 occurred. Conclusion: Bimodal radiotherapy including IMRT and active raster-scanning CIRT for high-risk nasopharyngeal cancer is a safe treatment method resulting in moderate toxicity and excellent local control. A larger patient number and longer follow-up time would be necessary to strengthen the current findings.

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