Feasibility and Efficacy of Single Photon Emission Computed Tomography-Based Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma 8 cm or More With Portal Vein Tumor Thrombus in Combination With Transcatheter Arterial Chemoembolization

Shirai, Shintaro; Sato, Morio; Suwa, Kazuhiro; Kishi, Kazushi; Shimono, Chigusa; Sonomura, Tetsuo; Kawai, Nobuyuki; Tanihata, Hirohiko; Minamiguchi, Hiroki; Nakai, Motoki

doi:10.1016/j.ijrobp.2009.03.023

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Volume 76, Issue 4 , Pages 1037-1044, 15 March 2010

Feasibility and Efficacy of Single Photon Emission Computed Tomography-Based Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma 8 cm or More With Portal Vein Tumor Thrombus in Combination With Transcatheter Arterial Chemoembolization

Shintaro Shirai, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Morio Sato, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
- Reprint requests to: Morio Sato, Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama Shi, Wakayama 641-8510, Japan. Tel: (+81) 73-441-0604; Fax: (+81) 73-444-3110
Kazuhiro Suwa, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Kazushi Kishi, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Chigusa Shimono, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Tetsuo Sonomura, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Nobuyuki Kawai, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Hirohiko Tanihata, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Hiroki Minamiguchi, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
Motoki Nakai, M.D.
- Department of Radiology, Wakayama Medical University, Wakayama, Japan

Received 31 October 2008; received in revised form 17 February 2009; accepted 4 March 2009. published online 19 June 2009.

Purpose

To assess the feasibility and efficacy of single photon emission computed tomography–based three-dimensional conformal radiotherapy (SPECT-B 3D-CRT) for large hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).

Methods and Materials

HCC patients with PVTT in the first branch or main trunk, 8 cm or greater in size, were admitted to the study. SPECT, using Tc-99m-galactosyl human serum albumin, was used in radiation treatment planning to explore the optimal irradiation beam angle. SPECT enabled the minimum possible irradiation of functional liver (FL). Clinical target volume (CTV) included the main tumor and PVTT. SPECT-B 3D-CRT targeted the CTV to a total dose of 45 Gy/18 fractions. HCC outside the CTV was treated by transcatheter arterial chemoembolization (TACE).

Results

Nineteen cases were enrolled in this study. The mean maximum dimension, mean CTV, and mean dose to FL were 11.0 cm (range, 8.0–20.0), 435 cm³ (range, 60–2,535), and 1,102 cGy (range, 691–1,695), respectively. Follow-up SPECT demonstrated radiation-induced dysfunctional liver. Despite the inclusion of 6 cases of Child-Pugh B or C, no patients experienced Grade 3 or worse radiation-induced liver disease. The cumulative non-progression rates of PVTT and PVTT plus main tumor were 78.0 and 43.2%, respectively. Survival rates at 1 and 2 years were 47.4 and 23.7%, respectively.

Conclusions

SPECT-B 3D-CRT with TACE appears to be tolerable to cirrhotic liver and to provide promising prognosis for patients with HCC sized 8 cm or more, in comparison with previous treatment methods. A longer follow-up period is required to evaluate these findings.

Functional image-guided radiotherapy, Three-dimensional conformal radiotherapy, Hepatocellular carcinoma, Portal vein tumor thrombus, Tc-99m-galactosyl human serum albumin