Treatment of primary liver cancer using highly-conformal radiotherapy with kv-image guidance and respiratory control

To implement a reliable, practical and reproducible treatment procedure, based on in-room kV-image guidance and respiratory control, for liver cancer patients treated with high dose conformal radiotherapy using a commercially available treatment system. CT stimulation was conducted under voluntary b...

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Bibliographic Details
Published in:Radiotherapy and oncology Vol. 102; no. 1; pp. 56 - 61
Main Authors: Law, Ada L.Y., Ng, Wai-Tong, Lee, Michael C.H., Chan, Augustine T.S., Fung, Kai-Hung, Li, Francis, Lao, Wai-Cheung, Lee, Anne W.M.
Format: Journal Article
Language:English
Published: Ireland Elsevier Ireland Ltd 01.01.2012
Subjects:
Aged
Aged, 80 and over
Biomarkers, Tumor - analysis
Carcinoma
Carcinoma, Hepatocellular - radiotherapy
Female
Follow-Up Studies
Hematology, Oncology and Palliative Medicine
Hepatocellular
Humans
Image-guided radiotherapy
Liver cancer
Liver neoplasm
Liver Neoplasms - radiotherapy
Male
Middle Aged
Patient Positioning
Quality of Life
Radiotherapy
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Conformal - methods
Remission Induction
Respiration
Respiratory control
Survival Rate
Treatment Outcome
Hepatocellular
Liver neoplasm
Liver cancer
Carcinoma
Image-guided radiotherapy
Respiratory control
Radiotherapy
ISSN:0167-8140, 1879-0887, 1879-0887
Online Access:Get full text
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Summary:To implement a reliable, practical and reproducible treatment procedure, based on in-room kV-image guidance and respiratory control, for liver cancer patients treated with high dose conformal radiotherapy using a commercially available treatment system. CT stimulation was conducted under voluntary breath hold or gating using the Varian Real-time Position Management™ (RPM) System. Treatments were delivered daily under kV image guidance to verify the diaphragmatic or lipiodol-defined tumor position. Thirty-three patients with liver confined hepatocellular carcinoma were treated between May 2006 and Dec 2009. After a median follow-up period of 16.5months (range: 3.5–40.7), all but 2 patients demonstrated radiological tumor regression. Eight patients (24%) achieved complete remission. The median tumor shrinkage was 42% (27–100%). Subsequent in-field tumor progression was observed in only three patients (10%). For the 23 patients with abnormal alpha fetoprotein level, 22 of them showed biochemical response with a median AFP level drop of 78%. The treatment was well tolerated: Grade 3 toxicities occurred in 5 patients (1 leucopenia, 1 elevated liver enzyme and 3 elevated bilirubin level) but there was no grade 4 toxicity or treatment related death. The 1year overall survival rate is 71.7% and median survival time is 17.2months (3.5–40.7months). Excellent treatment results with minimal toxicities could be achieved in a clinical environment with a commercially available highly sophisticated radiotherapy system.
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ISSN:0167-8140
1879-0887
1879-0887
DOI:10.1016/j.radonc.2011.05.022