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Dose escalation using helical tomotherapy improves local control in spine metastases fromprimary hepatic malignancies

 Yunseon Choi  ;  Junwon Kim  ;  Ikjae Lee  ;  Jinsil Seong 
 LIVER INTERNATIONAL, Vol.34(3) : 462-468, 2014 
Journal Title
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/pathology* ; Cholangiocarcinoma/pathology* ; Disease-Free Survival ; Female ; Humans ; Liver Neoplasms/pathology* ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Radiotherapy, Intensity-Modulated* ; Spinal Canal ; Spinal Neoplasms/diagnosis ; Spinal Neoplasms/radiotherapy* ; Spinal Neoplasms/secondary* ; Survival Analysis ; Tomography, X-Ray Computed ; Treatment Outcome
BACKGROUND & AIMS: This study was designed to reveal the prognostic significance of dose-escalated radiotherapy with tomotherapy in local control for spine metastases of primary hepatic tumours.
METHODS: From April 2006 to May 2012, 23 hepatocellular carcinoma patients and 7 intrahepatic cholangiocellular carcinoma patients (total 30 patients, 42 spinal lesions) were treated for metastatic spine lesions with helical tomotherapy (HT). The gross tumour volume (GTV) was defined as a tumour evident from computed tomography and magnetic resonance imaging. Median values were as follows: GTV total dose of 48 Gy (range 21-51), fraction size of 6 Gy (range 3-8) and eight fractions (range 3-17). Pain response was checked according to visual analogue scale (from 0 to 10).
RESULTS: The median follow-up was 5.6 months. Six events of local failure occurred, including five lesions in which spinal canals were involved at radiotherapy. Local control rate at 3 months was 86.6%. Biological equivalent dose (BED) was correlated with local control (AUC = 0.833). Higher BED (>56.0 Gy10 ) was associated with increased local control (P = 0.004). The median time to local progression in patients receiving ≤56.0 Gy10 and >56.0 Gy10 were 3 and 20.8 months respectively. Dose escalation (BED > 56.0 Gy10 ) was also associated with improved progression-free survival (median 14.7 vs. 2.8 months, P = 0.010). Pain reduction was observed in 90.9% (20/22) of patients with painful bone metastases.
CONCLUSIONS: Dose-escalated radiotherapy (BED > 56.0 Gy10 ) using HT improved local control in spinal metastases of hepatic malignancies.
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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
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
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