Recent research progress on surgery combined with radiation therapy for primary liver cancer / 中华放射肿瘤学杂志

Surgical resection is the main radical treatment of early and mid-stage primary liver cancer (PLC), but the high postoperative recurrence rate is the main factor affecting the curative effect. With recent advancement in techniques, the efficacy and safety of radiation therapy for PLC have been widely proven. In this review, we will investigate the combination of surgery and radiation therapy, covering the topics of preoperative or postoperative radiotherapy for PLC with portal vein tumor thrombus, postoperative adjuvant radiotherapy in PLC with narrow surgical margin or microvascular invasion, stereotactic body radiation therapy as a bridge to liver transplantation, radiotherapy in conversion to resectability for intrahepatic inoperable PLC. Despite radiation therapy is one of the effective therapeutic options for PLC, there is still a compelling need for prospective, randomized, controlled phase Ⅲ trials to acquire high-levelclinical evidence for confirming the role of radiation therapy in the treatment of PLC.

The comparison of two deformable registration algorithms and analysis of morphology of normal liver and tumor by breathing motion / 中华放射肿瘤学杂志

Objective To study the morphology of normal liver and tumors by breathing motion of hepatocellular carcinoma patients,through comparing the modified demons algorithm and FFD algorithm based on B-spline,and combing four-dimensional computed tomography (4DCT).Methods The 4DCT images of 8 HCC patients were segmented into 10-series which were named CT0,CT10 … CT80,CT90 according to the respiratory phases,CT0 and CT50 are defined to be end-inhale and end-exhale respectively.CT50 was chosen as the reference image.We used the modified demons algorithm and FFD algorithm based on B-spline to deform the images.Linear interpolation was used in both mode 1 and mode 2.The normalized mutual information (NMI),Hausdorff distance (dH) and registration speed were used to verify the registration performance.Results The average NMI for the end-inhale and end-exhale images of 8 HCC patients after demons registration in mode 1 improved 4.75％ with FFD algorithm based on B-spline(P =0.002).And the difference of dH after demons reduced 15.2％ comparing with FFD model algorithm (P =0.02).In addition,demons algorithm has the absolute advantage in registration speed(P =0.036).Conclusions The breathing movement for deformation of normal liver and tumor targets is significant.These two algorithms can achieve the registration of 4DCT images and the modified demons registration can deform 4DCT images effectively.

The individual internal gross target volume for hepatocellular carcinoma: four-dimensional CT vs three-dimensional CT associated with active breathing control / 中华放射肿瘤学杂志

Objective To research the feasibility of using three-dimensional CT (3DCT) associated with active breathing control (ABC) in determination of the individual internal tumor volume (ITV) for hepatocellular carcinoma (HCC) comparing the four-dimensional CT (4DCT).Methods After 4DCT scans of 15 HCC patients who had accepted TACE,completed the 3DCT scans associated with ABC in three ways of breathing:free breathing ( FB),end inspiration hold ( EIH),end expiration hold (EEH).4DCT images were sorted into 10 phases and the maximum intensity projection (MIP) images were constructed.The GTVs were manually contoured on 4DCT and 3DCT images (labeled as GTV0,GTV10.….GTV90,GTVMIP,,GTVFB,GTVEIH and GTVEEH).GTV0…GTV90,GTV0 and GTV50,GTV0,GTV20 and GTV50,GTVEIH and GTVEEH were respectively merged into IGTV1,IGTV2,IGTV3,IGTV4.The volume and geometry displacement of GTVs and IGTVs were compared.Results All patients were compatible with the ABC technique and completed the CT scans in two ways.The motion of diaphragm measured between 4DCT and 3DCT images was not significantly different ( 1.39 cm and 1.39 cm,t =-0.02,P =0.983 ),it was similar to the volume difference among GTV0,GTV20,GTV50,GTVEIH,GTVEEH and GTVFB (56.4,54.6,55.5,55.6,55.2,59.7 cm3,F =0.01,P =1.000 ).The comparison result of volume difference among IGTV1,IGTV2,IGTV3,IGTV4 and GTVMIP (77.9,71.4,73.4,72.3 and 66.3 cm3,F =0.02,P =1.000)were similar to the differences of geometry displacement in x,y and z axial among them (F =0.48,0.04,0.02,P =0.750,0.997,0.999,respectively).Conclusion The application of 3DCT associated with ABC in determination of the individual IGTV for HCC is feasible and safe comparing to 4DCT.

Definition of internal target volume and domestric study for hepatocellular carcinoma using four-dimensional CT / 中华放射肿瘤学杂志

Objective To define individualized internal target volume (ITV) for hepatocellular car-cinoma using four-dimensional (4D) CT, and to compare the differences in target volume definition and dose distribution among 3D, 4D and respiratory-gated plans. Methods 4DCT scanning was obtained for 12 pa-tients with hepatoceUular. Gross tumor volume (GTV), clnical target volume (CTV) and normal tissues were contoured on all 10 respiratory phases of 4DCT images. The 3D, 4D and gated treatment plans were prepared for each patient using three different planning target volumes (PTVs): 1) PTV3D was derived from a single CTV plus conventional margins;2) PTV4D was derived from ITV4D, which encompassed all 10 CTVs plus setup margins (SMs);3) PTV_(Gating) was derived from ITV_(Gating), which encompassed 3 CTVs within ga-ting-window at end-expiration plus SMs. The PTV volume and dose distribution were compared among differ-ent plans. Results The PTV3D was the largest in all 12 patients, but still missed partial target volume in 5 patients when comparing with PTV4D. Both the 4D plans and the gated plans spared more normal tissues than the 3D plans, especially the hver. Without increasing normal tissue dose, the 4D plans allowed for increas-ing the calculated dose from (50.8±2.0) Gy (3D plans) to (54.7±3.3) Gy, and the gated plans could further increase the dose to (58.0±3.9) Gy. Conclusions The 4DCT-based plans can ensure optimal tar-get coverage with less irradiation of normal tissues and allow dose escalation when compared with 3D plans.Respiratory gated radiotherapy can further reduce the target volumes to spare more surrounding tissues, espe-cially for patients with large extent of respiratory mobility.

Outcome of internal radiation with non-sealed colloidal phosphate (~(32)P) and macroaggregate albumin in primary hepatic carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the clinical responses and side effects of non sealed colloidal 32 P internal radiation and macroaggregate albumin (MAA) for hepatocellular carcinoma (HCC). Methods Twenty six patients with HCC underwent ultrasound guided intratumoral injection therapy of 32 P colloid and MAA. The clinical responses and toxic effects were analyzed on basis of clinical manifestions and laboratory data, including the tumor size, histopathological changes, serum alpha fetoprotein (AFP) estimation, blood routine, hepatic and renal functions and immunocompetence assays before and after treatment. Results Clinical responses: alleviation of symptoms, decreased AFP levels, fibrosis and complete or partial necrosis within tumor lesions (CR 2, PR 13, MR 2, SD 7 and PD 2). The total response rate was 57.7% and the median survival period was 16 months. Hepatic lesions became resectable in 5 patients for whom successful operation was performed. The 1 ,2 and 3 year survival rates were 88.5%, 76.9% and 38.5%, respectively. No evidence of non sealed radionuclide induced toxic reactions or complications were observed. Conclusions The treatment of internal radiation with 32 P colloid and macroaggregate albumin is effective, simple, safe and applicable with wide indications for primary hepatic carcinoma.