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.