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Phase I dose escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma

 Jun Won Kim  ;  Jinsil Seong  ;  Ik Jae Lee  ;  Joong Yeol Woo  ;  Kwang-Hyub Han 
 ONCOTARGET , Vol.7(26) : 40756-40766, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/radiotherapy* ; Disease-Free Survival ; Dose-Response Relationship, Drug ; Female ; Humans ; Liver Neoplasms/radiotherapy* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Prognosis ; Radiometry ; Radiosurgery/methods* ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated/methods* ; Treatment Outcome
dose escalation ; hepatocellular carcinoma ; intensity-modulated radiotherapy ; stereotactic body radiotherapy
BACKGROUND: Phase I trial was conducted to determine feasibility and toxicity of helical intensity-modulated radiotherapy (IMRT)-based stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC). RESULTS: Eighteen patients (22 lesions) were enrolled. With no DLT at 52 Gy (13 Gy/fraction), protocol was amended for further escalation to 60 Gy (15 Gy/fraction). Radiologic complete response rate was 88.9%. Two outfield intrahepatic, 2 distant, 4 concurrent local and outfield, and 1 concurrent local, outfield and distant failures (no local failure at dose levels 3-4) occurred. The worst toxicity was grade 3 hematologic in five patients, with no gastrointestinal toxicity > grade 1. At median follow-up of 28 months for living patients, 2-year local control, progression-free (PFS), and overall survival rates were 71.3%, 49.4% and 69.3%, respectively. Multi-segmental recurrences prior to SBRT was independent prognostic factor for PFS (p = 0.033). MATERIALS AND METHODS: Eligible patients had Child-Pugh's class A or B, unresectable HCC, ≤ 3 lesions, and cumulative tumor diameter ≤ 6 cm. Starting at 36 Gy in four fractions, dose was escalated with 2 Gy/fraction per dose-level. CTCAE v 3.0 ≥ grade 3 gastrointestinal toxicity and radiation induced liver disease defined dose-limiting toxicity (DLT). CONCLUSIONS: Helical IMRT-based SBRT was tolerable and showed encouraging results. Confirmatory phase II trial is underway.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Woo, Joong Yeol(우중열)
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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