Single Photon Emission Computed Tomography–Based Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

• Published in: International journal of radiation oncology, biology, physics Vol. 73; no. 3; pp. 824 - 831
• Main Authors: Shirai, Shintaro, M.D, Sato, Morio, M.D, Suwa, Kazuhiro, M.D, Kishi, Kazushi, M.D, Shimono, Chigusa, M.D, Kawai, Nobuyuki, M.D, Tanihata, Hirohiko, M.D, Minamiguchi, Hiroki, M.D, Nakai, Motoki, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2009
• Subjects: Aged; Aged, 80 and over; ALBUMINS; BLOOD SERUM; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - radiotherapy; Chemoembolization, Therapeutic - methods; CHILDREN; Female; Functional image-guided radiotherapy; Hematology, Oncology and Palliative Medicine; Hepatocellular carcinoma; HEPATOMAS; Humans; IRRADIATION; LIVER; Liver Cirrhosis - diagnostic imaging; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Male; Middle Aged; PATIENTS; Portal Vein - diagnostic imaging; Portal vein tumor thrombus; Prospective Studies; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiopharmaceuticals; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Survival Rate; Tc-99m-galactosyl human serum albumin; TECHNETIUM 99; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate; Three-dimensional conformal radiotherapy; Tomography, Emission-Computed, Single-Photon; TOXICITY; Tumor Burden; VEINS; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - radiotherapy; Venous Thrombosis - therapy; Hepatocellular carcinoma; Three-dimensional conformal radiotherapy; Tc-99m-galactosyl human serum albumin; Functional image-guided radiotherapy; Portal vein tumor thrombus
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2008.04.055

Purpose To evaluate the safety and efficacy of three-dimensional conformal radiotherapy (3D-CRT) using single photon emission computed tomography (SPECT) in unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods and Materials Patients with HCC with PVTT in the first branch and/or main trunk were selected for this study. The optimal beam directions for 3D-CRT were explored using a Tc-99m-galactosyl human serum albumin SPECT image for guidance. The SPECT image was classified as either wedge type or localized type. The clinical target volume to a total dose of 45 or 50 Gy per 18–20 fractions included the main tumor and PVTT in the wedge type and PVTT alone in the localized type. Results Twenty-six patients were enrolled: 18 with wedge type and 8 with localized type. Mean tumor size was 7.1 cm (range, 4.4–12.3 cm). Clinical target volumes of wedge type vs. localized type were 111.2 cm3 vs. 48.4 cm3 ( p = 0.010), respectively. Mean dose to normal liver and mean dose to functional liver were 1185 cGy and 988 cGy ( p = 0.001) in wedge type and 1046 cGy and 1043 cGy ( p = 0.658) in localized type, respectively. Despite an incidence of Child–Pugh B and C of 57.7%, no patients experienced radiation-induced liver disease. The progression of PVTT was inhibited, with an incidence of 92.2%; survival rates at 1 and 2 years were 44% and 30%, respectively. Conclusion Single photon emission computed tomography–based 3D-CRT enables irradiation of both the main tumor and PVTT with low toxicity and promising survival.