Feasibility and Efficacy of Single Photon Emission Computed Tomography-Based Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma 8 cm or More With Portal Vein Tumor Thrombus in Combination With Transcatheter Arterial Chemoembolization

Journal Article · Mon Mar 15 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.03.023· OSTI ID:21372157

Shirai, Shintaro ^[1]; Sato, Morio ^[1]; Suwa, Kazuhiro; Kishi, Kazushi; Shimono, Chigusa; Sonomura, Tetsuo; Kawai, Nobuyuki; Tanihata, Hirohiko; Minamiguchi, Hiroki; Nakai, Motoki ^[1]

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1. Department of Radiology, Wakayama Medical University, Wakayama (Japan)

Purpose: To assess the feasibility and efficacy of single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B 3D-CRT) for large hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods and Materials: HCC patients with PVTT in the first branch or main trunk, 8 cm or greater in size, were admitted to the study. SPECT, using Tc-99m-galactosyl human serum albumin, was used in radiation treatment planning to explore the optimal irradiation beam angle. SPECT enabled the minimum possible irradiation of functional liver (FL). Clinical target volume (CTV) included the main tumor and PVTT. SPECT-B 3D-CRT targeted the CTV to a total dose of 45 Gy/18 fractions. HCC outside the CTV was treated by transcatheter arterial chemoembolization (TACE). Results: Nineteen cases were enrolled in this study. The mean maximum dimension, mean CTV, and mean dose to FL were 11.0 cm (range, 8.0-20.0), 435 cm{sup 3} (range, 60-2,535), and 1,102 cGy (range, 691-1,695), respectively. Follow-up SPECT demonstrated radiation-induced dysfunctional liver. Despite the inclusion of 6 cases of Child-Pugh B or C, no patients experienced Grade 3 or worse radiation-induced liver disease. The cumulative non-progression rates of PVTT and PVTT plus main tumor were 78.0 and 43.2%, respectively. Survival rates at 1 and 2 years were 47.4 and 23.7%, respectively. Conclusions: SPECT-B 3D-CRT with TACE appears to be tolerable to cirrhotic liver and to provide promising prognosis for patients with HCC sized 8 cm or more, in comparison with previous treatment methods. A longer follow-up period is required to evaluate these findings.

• OSTI ID: 21372157
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 76, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2009.03.023; PII: S0360-3016(09)00458-1; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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