Risk factors for hepatitis B virus reactivation after conformal radiotherapy in patients with hepatocellular carcinoma.
Bottom Line: The HBV DNA level and dose volume parameters including normal liver volume, V20, and mean dose were associated with HBV reactivation.There was a relatively high incidence of HBV reactivation in HCC patients after the end of conformal RT.The serum HBV DNA level and some dosimetric parameters related to normal liver, including normal liver volume, V20, and mean dose, were the prognosis factors of HBV reactivation and should be carefully considered before conformal RT.
Affiliation: Department of Radiation Oncology VI, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Shandong's Key Laboratory of Radiation Oncology, Jinan, China.Show MeSH
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Mentions: For better tumor contouring, contrast phases of simulation CT were needed. All patients were given conformal RT, either 3-DCRT or IMRT, over a period of 5–7 weeks, which was delivered with linear accelerators using 6 or 15-MV X-rays. Twenty-nine patients in Shandong Cancer Hospital were treated with the active breathing control technique to reduce the motion of the liver. Treatment techniques typically included initial anterior–posterior beams followed by oblique off-cord beams. Most plans used four to eight fields and the prescribed dose was at the 90–95% isodose line. Each patient was delivered a daily fraction of 1.8–2.0 Gy up to total dose of 45–64 Gy in five fractions per week up to 25–32 fractions. The median prescription dose was 55.8 Gy. Several dosimetric parameters were calculated from the DVH, which was generated from the computerized treatment plan using the Pinncle3 Planning System (Philips Medical Systems, Fitchburg, WI, USA) for each patient. Gross tumor volume was defined as the hepatic tumor volume, visualized by 3-D computation of contrast CT-defined contours. Planning target volume included GTV and margins of 10–20 mm for primary tumors. Normal liver volume was defined as the total liver volume minus the GTV; VD was the relative volume of normal liver receiving more than a threshold dose D of radiation, and Dmean was the mean dose of normal liver. Figure1 shows typical examples of dose distribution image and DVH analysis in one patient who underwent RT.
Affiliation: Department of Radiation Oncology VI, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Shandong's Key Laboratory of Radiation Oncology, Jinan, China.