Zhao Qianqian, Wang Renben, Zhu Jian, Jin Linzhi, Zhu Kunli, Xu Xiaoqing, Feng Rui, Jiang Shumei, Qi Zhonghua, Yin Yong
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, People's Republic of China; Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.
Onco Targets Ther. 2016 Jun 24;9:3807-13. doi: 10.2147/OTT.S106869. eCollection 2016.
To compare the difference of liver sparing and dose escalation between three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy (HT) for hepatocellular carcinoma.
Sixteen unresectable HCC patients were enrolled in this study. First, some evaluation factors of 3DCRT, IMRT, and HT plans were calculated with prescription dose at 50 Gy/25 fractions. Then, the doses were increased using HT or IMRT independently until either the plans reached 70 Gy or any normal tissue reached the dose limit according to quantitative analysis of normal tissue effects in the clinic criteria.
The conformal index of 3DCRT was lower than that of IMRT (P<0.001) or HT (P<0.001), and the homogeneity index of 3DCRT was higher than that of IMRT (P<0.001) or HT (P<0.001). HT took the longest treatment time (P<0.001). For V 50% (fraction of normal liver treated to at least 50% of the isocenter dose) of the normal liver, there was a significant difference: 3DCRT > IMRT > HT (P<0.001). HT had a lower D mean (mean dose) and V 20 (V n, the percentage of organ volume receiving ≥n Gy) of liver compared with 3DCRT (P=0.005 and P=0.005, respectively) or IMRT (P=0.508 and P=0.007, respectively). D mean of nontarget normal liver and V 30 of liver were higher for 3DCRT than IMRT (P=0.005 and P=0.005, respectively) or HT (P=0.005 and P=0.005, respectively). Seven patients in IMRT (43.75%) and nine patients in HT (56.25%) reached the isodose 70 Gy, meeting the dose limit of the organs at risk.
HT may provide significantly better liver sparing and allow more patients to achieve higher prescription dose in HCC radiotherapy.
比较三维适形放疗（3DCRT）、调强放疗（IMRT）和螺旋断层放疗（HT）在肝细胞癌肝保护和剂量递增方面的差异。
16例不可切除的肝癌患者纳入本研究。首先，计算3DCRT、IMRT和HT计划在处方剂量为50 Gy/25次分割时的一些评估因素。然后，分别使用HT或IMRT增加剂量，直到计划达到70 Gy或根据临床标准对正常组织效应的定量分析显示任何正常组织达到剂量限制。
3DCRT的适形指数低于IMRT（P<0.001）或HT（P<0.001），3DCRT的均匀性指数高于IMRT（P<0.001）或HT（P<0.001）。HT的治疗时间最长（P<0.001）。对于正常肝脏的V50%（接受至少50%等中心剂量的正常肝脏部分），存在显著差异：3DCRT>IMRT>HT（P<0.001）。与3DCRT（分别为P=0.005和P=0.005）或IMRT（分别为P=0.508和P=0.007）相比，HT的肝脏Dmean（平均剂量）和V20（Vn，接受≥n Gy的器官体积百分比）较低。3DCRT的非靶正常肝脏Dmean和肝脏V30高于IMRT（分别为P=0.005和P=0.005）或HT（分别为P=0.005和P=0.005）。IMRT组7例患者（43.75%）和HT组9例患者（56.25%）达到70 Gy等剂量线，满足危及器官的剂量限制。
在肝癌放疗中，HT可能在肝保护方面显著更好，并使更多患者达到更高的处方剂量。
