Journal of Liver Cancer

Original Article

Selection of Proper Modality in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Seo hee Choi, Joong Yeol Woo, Jinsil Seong; J Liver Cancer. 2017;17(1):45-53. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.45

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Background/Aims
As the optimal stereotactic body radiation therapy (SBRT) modality for hepatocellular carcinoma (HCC) has not been confirmed, we aimed herein to provide a practical guideline by our retrospective review.
Methods
Thirty-nine patients with primary HCC who underwent liver SBRT via 3 modalities (helical tomotherapy [HT]: 22, volumetric modulated arc therapy [VMAT]: 13, Cyberknife: 4) at our institution between July 2014 and July 2015 were included. Modalities were compared with regard to dose conformity index (CI), homogeneity index (HI), clinical results, and patient compliance.
Results
VMAT SBRT had favorable conformity (CI: 0.7±0.2), homogeneity (HI: 1.1±0.0), and shortest treatment time (100.2±26.1 seconds). HT SBRT yielded good dosimetric outcomes, especially in conformity (CI: 1.0±0.2). Although the Cyberknife SBRT synchrony system allowed real-time tumor targeting, the treatment time was longest (3,015.0±447.3 seconds), invasive pre-treatment procedures were required, and the HI (1.3±0.0) was lowest.
Conclusions
All 3 modalities yielded competent dosimetric planning parameters. VMAT SBRT was most appropriate for tumors with residual lipiodol or patients with poor conditions. HT SBRT is available for multiple or irregular targets. Cyberknife SBRT is recommended for carefully selected patients and tumors indicated for sono-guided fiducial insertion.

Citations

Citations to this article as recorded by

Plan quality analysis of stereotactic ablative body radiotherapy treatment planning in liver tumor
Anirut Watcharawipha, Somvilai Chakrabandhu, Anupong Kongsa, Damrongsak Tippanya, Imjai Chitapanarux
Journal of Applied Clinical Medical Physics.2023;[Epub] CrossRef

Case Report

Hepatocellular Carcinoma Diagnosed with Metastatic Lesion of the Cervical Spine: Chung-Hwa Park, Myeong Jun Song, Hee Yeon Kim, Si Hyun Bae, Seung Kew Yoon, Jong Young Choi; Journal of the Korean Liver Cancer Study Group. 2010;10(1):61-63. Published online June 30, 2010

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Abstract PDF: Bone metastases in hepatocellular carcinoma (HCC) are usually treated with non-operative procedures such as radiotherapy, hormonal therapy, bisphosphonates, or sometimes with surgical procedures. Here we describe a case with 3rd cervical spine metastasis of HCC. A 62-year-old female with liver cirrhosis presented with neck pain. After evaluation, the patient was diagnosed of hepatocellular carcinoma with cervical spine metastasis. The metastatic lesion was treated with tomotherapy while the primary lesion in the liver was treated with transarterial chemoembolization using drug-eluting beads, and the patient is tolerable waiting for the next treatment.

Review Article

Clinical Experience of Tomotherapy in Oligometastasis and Metastatic Hepatocellular Carcinoma: Chul Seung Kay, Jee Yoon Kim, Jeong Won Jang; Journal of the Korean Liver Cancer Study Group. 2008;8(1):12-15. Published online June 30, 2008

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Abstract PDF: Extracranialoligometastasis is most common in lung, liver and bone. The standard treatment is systemic chemotherapy but the value of chemotherapy is limited. So, we can suppose the beneficial effects from the addition of local therapy such as metastasectomy, cooling or heating method of tumor and radiotherapy. Stereotactic body radiotherapy is an alternative approach for surgically unresectable lesions because of proximity to blood vessels or other critical structures and multilobar involvement and for the medically inoperable patients or patients who do not require surgery. Extrahepatic metastasis from hepatocellular carcinoma has no general agreement on the optimal treatment strategy. Helical tomotherapy, a new type of dynamic radiotherapy, is an intensity modulated radiotherapy system equipped with megavoltage computed tomography image guidance. We can precisely deliver high dose of radiation to the tumor with maximal sparing of around normal tissue and simultaneously irradiate the multiple tumor using tomotherapy. We introduce the clinical experience of tomotherapy in oligometastasis and metastatic hepatocellular carcinoma for the last several years.

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