Current Practice with Helical Tomotherapy in Yonsei University
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Transcript of Current Practice with Helical Tomotherapy in Yonsei University
Current Practice with Helical Tomotherapy in Yonsei University
Jinsil Seong, MD, PhDRadiation Oncology,
Yonsei University Medical College, Seoul, Korea
AERO/KIRAMS/YONSEI Liver Round Table Meeting, Seoul, Korea, 20130531
Tomotherapy in Yonsei;
• First installment; 2006• Under Yonsei University Health
System, 3 in Severance, 2 in Gangnam Severance, and 1 in Wonju >> total 6 machines
• No. 1 patients volume
• Tomotherapy for Liver Cancer is not covered by National Health Insurance
Evaluation for Dosimetric Superiority of Helical
Tomotherapy
Dosimetric Data of 3D-CRT, L-IMRT, & HT
Case Conformity Index
Dose Homo-geneity Index
No. 3D-CRT L-IMRT HT 3D-CRT L-IMRT HT1 2.25 1.14 1.03 1.10 1.06 1.042 2.24 1.15 1.04 1.10 1.06 1.023 1.62 1.16 1.03 1.08 1.06 1.034 1.94 1.18 1.06 1.05 1.06 1.035 1.69 1.23 1.06 1.08 1.05 1.006 1.73 1.17 1.04 1.05 1.06 1.037 6.25 1.15 1.08 1.19 1.06 1.028 2.05 1.21 1.03 1.12 1.05 1.039 1.65 1.48 1.23 1.05 1.08 1.01
10 2.22 2.05 1.11 1.07 1.09 1.0211 1.43 1.34 1.07 1.05 1.08 1.0212 1.48 1.32 1.09 1.09 1.12 1.01
Mean 2.21±1.30 1.30±0.25 1.07 ±0.06 1.09±0.04 1.07 ±0.02 1.02±0.01P-value 0.00 0.00
Dosimetric Data of 3D-CRT, L-IMRT, & HT
Organs at risk 3D-CRT L-IMRT HT p value
Remaining liver
Mean dose (Gy) 20.9±6.8 22.57±11.41 24.9±7.6 0.01
V40 (%) 17.8±10.3 29.4±12.1 17.8±13.8 0.04
V50 (%) 11.1±6.7 15.3±7.5 7.6±6.1 0.03
V60 (%) 3.9±3.2 2.1±1.5 0.4±0.3 0.01
Stomach
Mean dose (Gy) 16.1±10.4 22.62±5.72 21.3±6.3 0.11
V40 (%) 10.1±17.3 7.46±11.25 4.6±11.0 0.62
V50 (%) 6.8±13.4 2.61±6.1 2.0±6.0 0.39
V60 (%) 2.7±6.0 0.36±1.14 0.5±1.6 0.24
liver
stomach
kidney, rt
kidney, lt
Less mean dose to stomach in L-IMRT
(separated lesion in both lobes and left
lobe lesion)
Higher mean dose to left kidney in right lobe lesion.
• HT improves survival in HCC larger than 5 cm.
• HT-based SBRT is safe and effective in small HCC while further F/U is required.
Take Home Message
RTOG 1112: Randomized Phase III Study of Sorafenib versus SBRT followed by Sorafenib in Hepatocellular Carcinoma
STRATIFY
Vascular involvement (IVC, main portal vein/right or left main branch portal vein vs. other vascular involvement vs. none)
Hepatitis B vs. C vs. other
North American site vs. Non-North American site
HCC volume/liver volume (<10% vs. 10-40 vs. >40%)
RANDOMIZE
Arm 1
Daily sorafenib
Arm 2
SBRT alone (27.5 Gy – 50 Gy in 5 fractions)
Followed by
Sorafenib alone daily
• Patients
– Unsuitable for resection or transplant or radiofrequency ablation (RFA)
– Unsuitable for TACE or refractory to TACE
– Barcelona Clinic Liver Cancer Stage (BCLC) Intermediate (B) or Advanced (C)
• LINAC-based, Cyberknife, or protons