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Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

Intensitätsmodulierte Radiotherapie mit simultanem integriertem Boost beim inoperablen hepatozellulären Karzinom

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Abstract

Purpose

The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC).

Methods and materials

A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) < 1 cm from gastrointestinal structures, received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 (PTV1) and 2 (PTV2), respectively. The 12 patients in the high dose-fractionation (HD) group, with ITV ≥ 1 cm from gastrointestinal structures, received total doses of 66 and 55 Gy in 22 fractions to the PTV1 and PTV2, respectively.

Results

Overall, treatment was well tolerated, with no grade > 3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7 %) than patients in the HD group (p < 0.05 each). The median overall survival (OS) was 25.1 mKonzept ist machbar und sicheronths and the actuarial 2-year local progression-free survival (LPFS), relapse-free survival (RFS), and OS rates were 67.3, 14.7, and 54.7 %, respectively. The HD group tended to show better tumor response (100 vs. 62.2 %, p = 0.039) and 2-year LPFS (85.7 vs. 59 %, p = 0.119), RFS (38.1 vs. 7.3 %, p = 0.063), and OS (83.3 vs. 44.3 %, p = 0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS.

Conclusion

SIB-IMRT is feasible and safe for patients with inoperable HCC.

Zusammenfassung

Zielsetzung

Ziel der Arbeit war es, die klinische Wirksamkeit und die Sicherheit der intensitätsmodulierten Radiotherapie mit simultanem integriertem Boost (SIB-IMRT) für Patienten mit einem inoperablen hepatozellulären Karzinom (HCC) zu evaluieren.

Methode und Material

Bei 53 Patienten mit inoperablem HCC wurden zwei unterschiedliche Dosierungskonzepte je nach Lagebeziehung des internen Target-Volumens (ITV) zum gastrointestinalen (GI-)Trakt eingesetzt: Hochdosiskonzept (HD) und Niedrigdosiskonzept (LD). Bei 41 Patienten in der LD-Gruppe mit < 1 cm Abstand des ITV zum GI-Trakt wurden auf PTV1 55 Gy und auf PTV2 44 Gy in 22 Fraktionen appliziert. Bei 12 Patienten in der HD-Gruppe mit ≥ 1 cm Abstand wurden 66 und 55 Gy in 22 Fraktionen auf PTV1 und PTV2 gegeben.

Ergebnisse

Die Behandlung wurde gut vertragen und es wurden keine Toxizitäten > Grad 3 beobachtet. In der LD-Gruppe waren die Tumoren größer und hatten häufiger eine Gefäßinfiltration als in der HD-Gruppe (Median 6,0 vs. 3,4 cm und 80,6 vs. 16,7 %; jeweils p < 0,05). Die mediane Gesamtüberlebenszeit (mOS) betrug 25,1 Monate. Die 2-Jahres-Überlebensraten des lokalen progressionsfreien Überlebens (2J-LPFS), des rezidivfreien Überlebens (2J-RFS) und des 2J-OS lagen bei jeweils 67,3, 214,7 und 54,7 %. Die HD-Gruppe zeigte ein besseres Ansprechen (100 vs. 62,2 %, p = 0,039) und 2J-LPFS (85,7 vs. 59 %, p = n.s.), 2J-RFS 38.1 vs. 7,3 %, p = 0,063) und 2J-OS (83,3 vs. 44,3 %, p = 0,037) im Vergleich zur LD-Gruppe. Die multivariate Analyse zeigte, dass die Ansprechsrate signifikant mit dem OS korrelierte.

Schlussfolgerung

Das vorgestellte SIB-IMRT-Konzept ist machbar und sicher für Patienten mit einem inoperablen HCC.

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Acknowledgment

This study was supported by National Cancer Center Grant (NCC 1310080, 1340940 and 1410160). We greatly appreciate Dr. Joo-Young Kim, M.D., Sang-Jae Park, M.D., and Young-Hwan Koh, M.D., of National Cancer Center, Korea, for reviewing the manuscript and supporting the study.

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Authors and Affiliations

  1. Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro Ilsandong-gu, Goyang-si, 410-769, Gyeonggi-do, Republic of Korea

    Tae Hyun Kim M.D., Joong-Won Park M.D., Yeon-Joo Kim M.D., Bo Hyun Kim M.D., Sang Myung Woo M.D., Sung Ho Moon M.D., Sang Soo Kim Ph.D., Woo Jin Lee M.D., Dae Yong Kim M.D. & Chang-Min Kim M.D.

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  1. Tae Hyun Kim M.D.
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  2. Joong-Won Park M.D.
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Correspondence to Joong-Won Park M.D..

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Kim, T., Park, JW., Kim, YJ. et al. Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma. Strahlenther Onkol 190, 882–890 (2014). https://doi.org/10.1007/s00066-014-0643-z

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  • DOI: https://doi.org/10.1007/s00066-014-0643-z

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