- 期刊
3D-Conformal Radiotherapy of Unresectable and Unembolizable Advanced Hepatoma-A Pilot Study
順形放射治療對無法手術及栓塞的晚期肝癌之先導研究
摘要
Purpose: To conduct a pilot study on the feasibility of 3D-conformal radiotherapy on unresectable and unembolizable advanced hepatoma. Materials and Methods: From November 1996 to March 1998, 16 patients of 15 males and 1 female with median age 62 (range 26-80) were enrolled in this pilot study. All the patients have varying degree of liver cirrhosis. According to Child's classification, 8 patients were in Child' A, 7 in Child's B and I in Child's C. Two patients had diffuse disease, 11 with massive-nodular lesion (＞ = 7cm), 4 with smaller nodular lesion (＜7cm). All patients had their CT images taken at treatment position and contours of the tumor and normal tissues were defined. Tumor volume was bounded with 2cm margin bilaterally, 2.0 to 2.5cm in cranial and caudal direction depending on the extent of respiratory motion. The beam's eye view representation was used for treatment planning. Normal liver was maximally spared outside the target volume and irradiation was administered daily using 10 MV X-rays at 1.8-2Gy per fraction. The percent volume of normal liver irradiated by 50% of target dose or greater (% VNLD50) would determine total dose given. Results: Eight patients had % VNLD50 less than 40 and the median dose given was 60.1Gy (range 49-68Gy). There were 3 PR (partial response), 3 SD (stable disease), 1 CR (complete response) and 1 PD (progressive disease). There were two patients died of fatal radiation hepatitis. Six patients were in the group having 33 to 66 % VNLDSO and median dose was 49.4Gy (range 40-64Gy). There were 4 SD and 2 PD. Two patients suffered from non-fatal radiation hepatitis and 1 patient died of fatal hepatitis. Two patients had %VNLD50 greater than 66. One was SD and another one had PD. One patient died of fatal radiation hepatitis. Median follow-up time was 7 months. Overall response rate was 25%. Median survival was 7 months (range 1-16). Six-month survival rate was 50% and that of 1 2-month was 37.5%. Conclusion: Selected cases of hepatoma that has %VNLDSO under 40 can be'considered for 3D-conformal radiotherapy but the correlation of radiation dose and radiation induced liver damage still need further investigation. For cases with % VNLD50 greater than 66, there is no clinical benefit of performing 3D-oonformal radiotherapy.
並列摘要
Purpose: To conduct a pilot study on the feasibility of 3D-conformal radiotherapy on unresectable and unembolizable advanced hepatoma. Materials and Methods: From November 1996 to March 1998, 16 patients of 15 males and 1 female with median age 62 (range 26-80) were enrolled in this pilot study. All the patients have varying degree of liver cirrhosis. According to Child's classification, 8 patients were in Child' A, 7 in Child's B and I in Child's C. Two patients had diffuse disease, 11 with massive-nodular lesion (＞ = 7cm), 4 with smaller nodular lesion (＜7cm). All patients had their CT images taken at treatment position and contours of the tumor and normal tissues were defined. Tumor volume was bounded with 2cm margin bilaterally, 2.0 to 2.5cm in cranial and caudal direction depending on the extent of respiratory motion. The beam's eye view representation was used for treatment planning. Normal liver was maximally spared outside the target volume and irradiation was administered daily using 10 MV X-rays at 1.8-2Gy per fraction. The percent volume of normal liver irradiated by 50% of target dose or greater (% VNLD50) would determine total dose given. Results: Eight patients had % VNLD50 less than 40 and the median dose given was 60.1Gy (range 49-68Gy). There were 3 PR (partial response), 3 SD (stable disease), 1 CR (complete response) and 1 PD (progressive disease). There were two patients died of fatal radiation hepatitis. Six patients were in the group having 33 to 66 % VNLDSO and median dose was 49.4Gy (range 40-64Gy). There were 4 SD and 2 PD. Two patients suffered from non-fatal radiation hepatitis and 1 patient died of fatal hepatitis. Two patients had %VNLD50 greater than 66. One was SD and another one had PD. One patient died of fatal radiation hepatitis. Median follow-up time was 7 months. Overall response rate was 25%. Median survival was 7 months (range 1-16). Six-month survival rate was 50% and that of 1 2-month was 37.5%. Conclusion: Selected cases of hepatoma that has %VNLDSO under 40 can be'considered for 3D-conformal radiotherapy but the correlation of radiation dose and radiation induced liver damage still need further investigation. For cases with % VNLD50 greater than 66, there is no clinical benefit of performing 3D-oonformal radiotherapy.
延伸閱讀
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