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Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients. Early clinical outcome and toxicity profile from a retrospective analysis of 138 patients.

Wang PM, Hsu WC, Chung NN, Chang FL, Fogliata A, Cozzi L - Radiat Oncol (2012)

Bottom Line: Median follow-up time was 9 months.One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3).Radiation-induced liver disease was observed in 34 patients (25%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan.

ABSTRACT

Background: To report early outcome and toxicity for inoperable patients with hepatocellular carcinoma (HCC) treated with volumetric modulated arc therapy (VMAT).

Methods: One hundred and thirty eight patients were retrospectively analysed. Dose prescription ranged from 45 to 66 Gy with conventional fractionation regime. Based on AJCC staging, 88.4% presented stage III or IV. Two-thirds (69.6%) were Child-Pugh stage A, the remaining were stage B. According to Barcelona Clinic Liver Cancer staging, 72.5% of patients were classified as stage C.

Results: Median age was 66 years, median tumor volume was 516 cm(3) (28 to 3620 cm(3)). The most patients (83%) were treated with 60 Gy. Median follow-up time was 9 months. One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3). Local control was achieved in 94% (of 109 assessable patients), stable disease in 29%, partial response in 53%, complete response in 11%, and progression in 6%. Radiation-induced liver disease was observed in 34 patients (25%). Gastrointestinal grade 3 toxicity was modest with a total of 17 (12.3%) cases for all endpoints.

Conclusions: Clinical results could suggest to introduce VMAT as an appropriate technique for the patients with HCC.

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Schematic representation of the institutional guidelines for the treatment management of HCC patients.
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Figure 1: Schematic representation of the institutional guidelines for the treatment management of HCC patients.

Mentions: Between February 2009 and December 2010, 138 consecutive HCC patients presented Barcelona Clinic Liver Cancer (BCLC) stage A to C and were eligible for curative or palliative radiotherapy (in eventual association to other therapeutic modalities) at the home institute. Figure 1 represents the institutional guidelines for HCC treatment. In brief, BCLC stages A to C, Child-Pugh stages A-B with single lesions larger than 5cm or multi-nodular lesions larger than 3cm were eligible for radiotherapy. All patients were inoperable or not eligible for TACE treatments and received radiotherapy as primary treatment. Portal vein thrombosis was present in about 50% of the cases. Relative contraindication to inclusion were: total bilirubin levels greater than 3 to 5 mg/dL; white blood count (WBC) less than 2500–1500 U/?L; Glutamic pyruvic transaminase (GPT) in the range 100–300 U/L. Absolute exclusion criteria included total bilirubin >5 mg/dL, WBC<1500 U/?L and GPT>300 U/L.


Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients. Early clinical outcome and toxicity profile from a retrospective analysis of 138 patients.

Wang PM, Hsu WC, Chung NN, Chang FL, Fogliata A, Cozzi L - Radiat Oncol (2012)

Schematic representation of the institutional guidelines for the treatment management of HCC patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539879&req=5

Figure 1: Schematic representation of the institutional guidelines for the treatment management of HCC patients.
Mentions: Between February 2009 and December 2010, 138 consecutive HCC patients presented Barcelona Clinic Liver Cancer (BCLC) stage A to C and were eligible for curative or palliative radiotherapy (in eventual association to other therapeutic modalities) at the home institute. Figure 1 represents the institutional guidelines for HCC treatment. In brief, BCLC stages A to C, Child-Pugh stages A-B with single lesions larger than 5cm or multi-nodular lesions larger than 3cm were eligible for radiotherapy. All patients were inoperable or not eligible for TACE treatments and received radiotherapy as primary treatment. Portal vein thrombosis was present in about 50% of the cases. Relative contraindication to inclusion were: total bilirubin levels greater than 3 to 5 mg/dL; white blood count (WBC) less than 2500–1500 U/?L; Glutamic pyruvic transaminase (GPT) in the range 100–300 U/L. Absolute exclusion criteria included total bilirubin >5 mg/dL, WBC<1500 U/?L and GPT>300 U/L.

Bottom Line: Median follow-up time was 9 months.One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3).Radiation-induced liver disease was observed in 34 patients (25%).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan.

ABSTRACT

Background: To report early outcome and toxicity for inoperable patients with hepatocellular carcinoma (HCC) treated with volumetric modulated arc therapy (VMAT).

Methods: One hundred and thirty eight patients were retrospectively analysed. Dose prescription ranged from 45 to 66 Gy with conventional fractionation regime. Based on AJCC staging, 88.4% presented stage III or IV. Two-thirds (69.6%) were Child-Pugh stage A, the remaining were stage B. According to Barcelona Clinic Liver Cancer staging, 72.5% of patients were classified as stage C.

Results: Median age was 66 years, median tumor volume was 516 cm(3) (28 to 3620 cm(3)). The most patients (83%) were treated with 60 Gy. Median follow-up time was 9 months. One-year overall survival rate was 45% (100% for AJCC stage I, 83% for stage II, 45% for stage III and 28% for stage IV), median survival was 10.3 months (95% C.I. 7.2-13.3). Local control was achieved in 94% (of 109 assessable patients), stable disease in 29%, partial response in 53%, complete response in 11%, and progression in 6%. Radiation-induced liver disease was observed in 34 patients (25%). Gastrointestinal grade 3 toxicity was modest with a total of 17 (12.3%) cases for all endpoints.

Conclusions: Clinical results could suggest to introduce VMAT as an appropriate technique for the patients with HCC.

Show MeSH
Related in: MedlinePlus