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RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma

RapidArc in Verbindung mit aktiver Atemkoordination ist eine wirksame und genaue Vorgehensweise bei der Strahlentherapie des hepatozellulären Karzinoms

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Abstract

Purpose

The goal of this research was to investigate the feasibility of volumetric modulated arc therapy, RapidArc (RA), in association with the active breathing coordinator (ABC) for the treatment of hepatocellular carcinoma (HCC) with radiotherapy.

Patients and materials

A total of 12 patients with HCC, after receiving transcatheter arterial chemoembolization (TACE) treatment, underwent three-dimensional computer tomography (3D-CT) scanning associated with ABC using end inspiration hold (EIH), end expiration hold (EEH), and free breathing (FB) techniques. The three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and RA plans (three 135° arcs) were designed on different CT images, respectively. The liver volume, gross tumor volume (GTV), and planning target volume (PTV) of the three breath status and the dosimetric differences of the different plans were compared.

Results

There were no significant differences in the volumes of live and GTV between the three breathing techniques (p > 0.05); the PTV in FB was greater than in the EEH and EIH (p < 0.05). The overall conformality index (CI) and homogeneity index (HI) for RA (CI 0.92, HI 0.90) were better than IMRT (CI 0.90, HI 0.89) and 3D-CRT (CI 0.70, HI 0.84) for the three breathing techniques (p< 0.05). The RA and IMRT significantly reduced the mean dose, V20, V30, and V40 of normal liver compared to 3D-CRT, while the V5 and V10 in RA were higher than in IMRT. The mean values in mean dose, V10, V20, V30, and V40 of the normal liver were reduced from 13.12 Gy, 46%, 24%, 13%, and 8% in RAFB to 10.23 Gy, 35%, 16%, 8%, and 5% in RAEEH and 9.23 Gy, 32%, 16%, 8%, and 5% in RAEIH , respectively. In addition, the treatment time of RA was equal to 3D-CRT, which was significantly shorter than IMRT.

Conclusion

RA in conjunction with ABC for the treatment of HCC with radiotherapy can achieve better dose delivery and ensure the accuracy of the target volume, which spares more organs at risk, uses fewer monitor units, and shortens treatment time.

Zusammenfassung

Ziel

Prüfung der Möglichkeit der volumetrisch modulierten Bogentherapie, RapidArc (RA), in Verbindung mit einer aktiven Atemkoordination („activ breathing coordinator“, ABC) bei der Behandlung von hepatozellulären Karzinomen („hepatocellular carcinoma“, HCC) mit Strahlentherapie.

Patienten und Material

Insgesamt 12 Patienten mit HCC unterzogen sich nach einer transkatheter-arteriellen Chemoembolisation („transcatheter arterial chemoembolization“, TACE)-Behandlung einer dreidimensionalen Computertomographie (3D-CT), verbunden mit einer aktiven Atemkoordination (ABC), die Endinspirationsfluss („end inspiration hold“, EIH), Endexpirationsfluss („end expiration hold“, EEH) und freie Atmung („free breathing“, FB) einbezog. Die 3D-konforme Strahlentherapie (3D-CRT), die intensitätsmodulierte Strahlentherapie (IMRT) und die RA-Pläne (drei 135°-Bögen) wurden jeweils auf verschiedenen CT-Bildern entworfen. Das Lebervolumen, das Gesamttumorvolumen („gross tumor volume“, GTV) und das Planzielvolumen („plan target volume“, PTV) wurden unter Anwendung von 3 Atemtechniken verglichen, ebenso die dosimetrischen Unterschiede der verschiedenen Pläne.

Ergebnisse

Es gab keine signifikanten Unterschiede bezüglich des Lebervolumens und des GTV bei den 3 Atemtechniken (p > 0,05); jedoch war das PTV in FB größer als im EEH und im EIH (p < 0,05). Der globale konformale Index („conformal index“, CI) und Homogenitätsindex („homogeneity index“, HI) für RA (CI 0,92; HI 0,90) waren für die 3 Atemtechniken (p < 0,05) besser als IMRT (CI 0,90; HI 0,89) und 3D-CRT (CI 0,70; HI 0,84). Die RA- und IMRT-Pläne verringerten im Vergleich zu 3D-CRT erheblich die mittlere Dosis, V20, V30 und V40 der normalen Leber, während V5 und V10 in RA höher waren als bei IMRT. Beim Vergleich der RA-Pläne für die verschiedenen Atemtechniken verringerten sich die mittlere Dosis, V10, V20, V30 und V40 der normalen Leber von 13,12 Gy, 46%, 24%, 13% und 8% bei RAFB auf 10,23 Gy, 35%, 16%, 8% und 5% bei RAEEH und auf 9,23 Gy, 32%, 16%, 8% und 5% bei RAEIH. Darüber hinaus war die Behandlungzeit von RA identisch mit der von 3D-CRT und damit erheblich kürzer als IMRT.

Zusammenfassung

RA in Verbindung mit ABC für die Behandlung von HCC mit Strahlentherapie kann eine bessere Strahlungsdosis erzielen und die Genauigkeit des Zielvolumens sicherstellen, was gefährdete Organe („organs at risk“, OARs) besser schont. Zudem werde weniger Anzeigegeräte benötigt, und die Behandlungzeit wird kürzer.

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Acknowledgments

We are grateful to Fu-Jing Huang, Xing-Peng Yang, and Wei Deng for their contributions in the writing of this paper.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Academy of Medical Sciences, 440 Jiyan Road, 250117, Jinan, China

    G.Z. Gong, Y. Yin, L.G. Xing, Y.J. Guo, T. Liu, J. Chen, J. Lu, C. Ma, T. Sun, T. Bai, G. Zhang & R. Wang

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  1. G.Z. Gong
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  2. Y. Yin
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Correspondence to Y. Yin.

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Gong, G., Yin, Y., Xing, L. et al. RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma. Strahlenther Onkol 188, 262–268 (2012). https://doi.org/10.1007/s00066-011-0044-5

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  • DOI: https://doi.org/10.1007/s00066-011-0044-5

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