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      The impact of beam angle configuration of intensity-modulated radiotherapy in the hepatocellular carcinoma

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC).

          Materials and Methods

          The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72° (Plan I), and beams with a 30° angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared.

          Results

          Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans.

          Conclusion

          The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.

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          Most cited references15

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          Radiation-associated liver injury.

          Charlie Pan, Brian D Kavanagh, Laura Dawson … (2010)
          The liver is a critically important organ that has numerous functions including the production of bile, metabolism of ingested nutrients, elimination of many waste products, glycogen storage, and plasma protein synthesis. The liver is often incidentally irradiated during radiation therapy (RT) for tumors in the upper- abdomen, right lower lung, distal esophagus, or during whole abdomen or whole body RT. This article describes the endpoints, time-course, and dose-volume effect of radiation on the liver. Published by Elsevier Inc.
          Article 0 comments Cited 210 times – based on 0 reviews     Review now
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            A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note.

            I Paddick (2000)
            A conformity index is a measure of how well the volume of a radiosurgical dose distribution conforms to the size and shape of a target volume. Because the success of radiosurgery is related to the extremely conformal irradiation of the target, an accurate method for describing this parameter is important. Existing conformity ratios and indices used in radiosurgery are reviewed and criticized. It will be demonstrated that previously proposed measurements of conformity can, under certain conditions, give false perfect scores. A new conformity index is derived that gives an objective score of conformity for a treatment plan and gives no false scores. An analysis of five different treatment plans is made using both the existing scoring methods and the new conformity index.
            Article 0 comments Cited 199 times – based on 0 reviews     Review now
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              Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies.

              Charlie Pan, Randall Ten Haken, Theodore S. Lawrence … (2005)
              A phase II trial was conducted to determine if high-dose radiation with concurrent hepatic arterial floxuridine would improve survival in patients with unresectable intrahepatic malignancies. Three-dimensional conformal high-dose radiation therapy was delivered concurrently with hepatic arterial floxuridine in 128 patients. The radiation dose was based on a normal-tissue complication probability model and subjected the patient to an estimated maximum risk of radiation-induced liver disease of 10% to 15%. The study design provided more than 80% power to detect a two-fold increase in median survival compared with historical controls at a 5% significance level. The median radiation dose delivered was 60.75 Gy (1.5-Gy fractions bid). At a median follow-up time of 16 months (26 months in patients who were alive) the median survival was 15.8 months (95% CI, 12.6 to 18.3 months), significantly longer than in the historical control. The actuarial 3-year survival was 17%. The total dose was the only significant predictor of survival. Primary hepatobiliary tumors had a significantly greater tendency to remain confined to the liver than did colorectal cancer metastases. Overall toxicity was acceptable, with 27 patients (21%) and 11 patients (9%) developing grade 3 and 4 toxicity, respectively, and one treatment-related death. The results suggest that, compared with historical controls, high-dose focal liver irradiation with hepatic artery floxuridine prolongs survival in patients with unresectable chemotherapy-refractory metastatic colorectal cancer and primary hepatobiliary tumors. This provides a rationale for intensification of local therapy for unresectable hepatobiliary cancers and integration of this regimen with newer systemic therapy for patients with colorectal cancer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Radiat Oncol J
                Journal ID (iso-abbrev): Radiat Oncol J
                Journal ID (publisher-id): ROJ
                Title: Radiation Oncology Journal
                Publisher: The Korean Society for Radiation Oncology
                ISSN (Print): 2234-1900
                ISSN (Electronic): 2234-3164
                Publication date (Print): September 2012
                Publication date (Electronic): 30 September 2012
                Volume: 30
                Issue: 3
                Pages: 146-151
                Affiliations
                [1 ]Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea.
                [2 ]Department of Physics, Yeungnam University, Gyeongsan, Korea.
                Author notes
                Correspondence: Min Kyu Kang, MD, Department of Radiation Oncology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. Tel: +82-53-620-3370, Fax: +82-53-624-3599, mkkang@ 123456ynu.ac.kr
                Article
                DOI: 10.3857/roj.2012.30.3.146
                PMC ID: 3496849
                PubMed ID: 23170294
                SO-VID: e619a8b4-0a0d-4406-9724-d5f006a85a8e
                Copyright © Copyright © 2012. The Korean Society for Radiation Oncology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 April 2012
                Date revision received : 26 May 2012
                Date accepted : 13 June 2012
                Categories
                Subject: Original Article
                Subject: Physics Contribution

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: intensity modulated radiation therapy,hepatocellular carcinoma,radiation therapy
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: intensity modulated radiation therapy, hepatocellular carcinoma, radiation therapy

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