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Helical TomoTherapy for Lung Metastases in Hepatocellular Carcinoma
I. J. Radiation Oncology d Biology d Physics
S584
2851
Volume 78, Number 3, Supplement, 2010
Helical TomoTherapy for Lung Metastases in Hepatocellular Carcinoma
1,2
C. Kay , J. Kim3,4, E. Yoo1,2, Y. Kang5,2, J. Jang1,2, J. Kwon1,4, K. Kim1,2 1 Incheon St. Mary’s Hospital, Incheon, Republic of Korea, 2Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 3Yeoido St. Mary’s Hospital, Seoul, Republic of Korea, 4Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 5Seoul St. Mary’s Hospital, Seoul, Republic of Korea
Purpose/Objective(s): Treatment of pulmonary metastases from hepatocellular carcinoma (HCC) is challenging because of its grave prognosis. Recently, stereotactic body radiotherapy (SBRT) has been widely applied in metastatic tumors and helical tomotherapy is newly developed as one of SBRT techniques. We retrospectively investigated the clinical efficacy of multiple lung metastases of HCC after helical tomotherapy. Materials/Methods: Twenty-one patients with multiple lung metastases of HCC were treated with helical tomotherapy. For simulation and computer planning, we performed two series of CT scans in inspiratory and expiratory phases to track the motion of tumor and internal organs. The median number of metastases was 5.00 (range, 110). The radiation dose of 44.01 Gy (range, 3055 Gy) and 38.01 Gy (range, 2750 Gy) as mean values was delivered to gross tumor volume and planning target volume, respectively, with 10 fractions during 2 weeks. For evaluation of the response after tomotherapy, RECIST (response evaluation criteria in solid tumor) version 1.0 was applied at 1 and 3 months after treatment. We analyzed the patient’s survival and prognostic factors by Kaplan-Meyer method and Cox regression analysis. To assess treatment related complications, we used CTCAE (common terminology criteria for adverse events) version 4.0. Results: The response rates at 1 and 3 months after tomotherapy were 47.6% (CR, 14.3%; PR, 33.3%) and 52.9% (CR, 11.8%; PR, 41.2%), respectively. Median survival and one year survival rate were 14.0 ± 1.9 months and 59.86%, respectively. Local control rate was 66.7% and median progression free survival was 6.0 ± 0.8 months. Most of patients (81%) ultimately experienced treatment failure such as local failure (19%), regional failure (14.3%), synchronous local and regional failure (14.3%), distant failure (28.6%) and synchronous regional and distant failure (4.8%) after treatment. The overall survival was better in 5 or less metastases and previous chemotherapy (p \ 0.05) and superior progression free survival was noted in 5 or less metastases, previous chemotherapy and good response at 3 months after tomotherapy (p \ 0.05). There was no grade 4 toxicity or treatment related death. Conclusions: Helical tomotherapy was thought feasible in multiple pulmonary metastases of HCC patients. We could suggest tomotherapy as an additional treatment option in certain group of patients such as five or less pulmonary metastases or previous chemotherapy. However, large controlled clinical trial should be followed to corroborate our data. Author Disclosure: C. Kay, None; J. Kim, None; E. Yoo, None; Y. Kang, None; J. Jang, None; J. Kwon, None; K. Kim, None.
2852
An Image-plan-treat System For Emergency Radiation Treatments
E. E. Ahunbay, F. J. Wilson, A. X. Li Medical College of Wisconsin, Milwaukee, WI Purpose/Objective(s): Emergency radiation treatments (RT) are often delivered using simple non-customized beam configurations, since the patient specific plans cannot be generated within an acceptable time frame. Simple beam configurations do not ensure optimal doses delivered. We investigated the feasibility of using of a fast planning technique, originally developed for online adaptive replanning, to rapidly generate plans for emergency RT. Materials/Methods: The imaging and planning process include (i) acquiring the CT in the treatment room using a CT-on-Rails (CTVision, Siemens), (ii) generating contours of the target and organs at risk (OAR) by auto-segmentation with manual editing if necessary, (iii) morphing beam/segment apertures of an existing sample plan based on newly-generated contours, (iv) optimizing weights of the new apertures, (v) evaluating dose distributions and DVHs, (vi) verifying MU numbers with an independent MU calculation, (vii) transferring beam parameters to the delivery machine, and (viii) verifying all beam parameters including leaf positions with an automatic tool prior to the delivery. The online adaptive replanning system (RealArt, Prowess) was used to perform the steps (ii) - (v). The planning process (steps (ii) to (viii) above) was tested using the CT data of 3 spine and 3 chest cases previously treated with either single or opposing beams for emergency care. Two sample IMRT plans, one for chest, and one for spine, were generated using 9 beams and 45 segments and stored in the Prowess system. The IMRT plan for the spine case was optimized to minimize dose spillage outside the target volume, while the plan for the chest case minimized doses to lung, esophagus and cord. For each of the 3 chest and 3 spine cases, an emergency treatment plan was generated by modifying the corresponding sample plan based on the CT of the case following the above planning process. Results: Generating an emergency RT plan can be completed within 10-20 minutes. Contour generation by the auto-segmentation with manual editing required in the range of 5 - 15 minutes, depending on the degree of manual editing and the number of contours required. Emergency RT plans generated in this way lead to more conformal dose distribution with improved OAR sparing (e.g., 5%-15% reduction in cord max dose) and lower hot spots (reduced by 10%-15%), as compared to those delivered with conventional simple emergency beam configurations. Conclusions: A fast planning system developed originally for online adaptive replanning can be used to generate conformal dosimetric plans for emergency radiation treatments within an acceptable time frame and enabling image-plan-treat in a single patient setup. Author Disclosure: E.E. Ahunbay, None; F.J. Wilson, None; A.X. Li, None.
2853
Whole-brain Radiotherapy in the Treatment of Brain Metastases: A 12-year Analysis of Prognostic Factors and Survival
M. G. Silva1, F. C. Gomes1, E. Y. Saito2, M. A. C. Maia1, J. V. Salvajoli1 1
Hospital A C Camargo, Sao Paulo, Brazil, 2Hospital Aristidez Maltez, Salvador, Brazil
Purpose/Objective(s): To report prognostic factors associated with survival in patients with brain metastases treated with wholebrain radiotherapy (WBRT) in a 12-year period.
S584
2851
Volume 78, Number 3, Supplement, 2010
Helical TomoTherapy for Lung Metastases in Hepatocellular Carcinoma
1,2
C. Kay , J. Kim3,4, E. Yoo1,2, Y. Kang5,2, J. Jang1,2, J. Kwon1,4, K. Kim1,2 1 Incheon St. Mary’s Hospital, Incheon, Republic of Korea, 2Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 3Yeoido St. Mary’s Hospital, Seoul, Republic of Korea, 4Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 5Seoul St. Mary’s Hospital, Seoul, Republic of Korea
Purpose/Objective(s): Treatment of pulmonary metastases from hepatocellular carcinoma (HCC) is challenging because of its grave prognosis. Recently, stereotactic body radiotherapy (SBRT) has been widely applied in metastatic tumors and helical tomotherapy is newly developed as one of SBRT techniques. We retrospectively investigated the clinical efficacy of multiple lung metastases of HCC after helical tomotherapy. Materials/Methods: Twenty-one patients with multiple lung metastases of HCC were treated with helical tomotherapy. For simulation and computer planning, we performed two series of CT scans in inspiratory and expiratory phases to track the motion of tumor and internal organs. The median number of metastases was 5.00 (range, 110). The radiation dose of 44.01 Gy (range, 3055 Gy) and 38.01 Gy (range, 2750 Gy) as mean values was delivered to gross tumor volume and planning target volume, respectively, with 10 fractions during 2 weeks. For evaluation of the response after tomotherapy, RECIST (response evaluation criteria in solid tumor) version 1.0 was applied at 1 and 3 months after treatment. We analyzed the patient’s survival and prognostic factors by Kaplan-Meyer method and Cox regression analysis. To assess treatment related complications, we used CTCAE (common terminology criteria for adverse events) version 4.0. Results: The response rates at 1 and 3 months after tomotherapy were 47.6% (CR, 14.3%; PR, 33.3%) and 52.9% (CR, 11.8%; PR, 41.2%), respectively. Median survival and one year survival rate were 14.0 ± 1.9 months and 59.86%, respectively. Local control rate was 66.7% and median progression free survival was 6.0 ± 0.8 months. Most of patients (81%) ultimately experienced treatment failure such as local failure (19%), regional failure (14.3%), synchronous local and regional failure (14.3%), distant failure (28.6%) and synchronous regional and distant failure (4.8%) after treatment. The overall survival was better in 5 or less metastases and previous chemotherapy (p \ 0.05) and superior progression free survival was noted in 5 or less metastases, previous chemotherapy and good response at 3 months after tomotherapy (p \ 0.05). There was no grade 4 toxicity or treatment related death. Conclusions: Helical tomotherapy was thought feasible in multiple pulmonary metastases of HCC patients. We could suggest tomotherapy as an additional treatment option in certain group of patients such as five or less pulmonary metastases or previous chemotherapy. However, large controlled clinical trial should be followed to corroborate our data. Author Disclosure: C. Kay, None; J. Kim, None; E. Yoo, None; Y. Kang, None; J. Jang, None; J. Kwon, None; K. Kim, None.
2852
An Image-plan-treat System For Emergency Radiation Treatments
E. E. Ahunbay, F. J. Wilson, A. X. Li Medical College of Wisconsin, Milwaukee, WI Purpose/Objective(s): Emergency radiation treatments (RT) are often delivered using simple non-customized beam configurations, since the patient specific plans cannot be generated within an acceptable time frame. Simple beam configurations do not ensure optimal doses delivered. We investigated the feasibility of using of a fast planning technique, originally developed for online adaptive replanning, to rapidly generate plans for emergency RT. Materials/Methods: The imaging and planning process include (i) acquiring the CT in the treatment room using a CT-on-Rails (CTVision, Siemens), (ii) generating contours of the target and organs at risk (OAR) by auto-segmentation with manual editing if necessary, (iii) morphing beam/segment apertures of an existing sample plan based on newly-generated contours, (iv) optimizing weights of the new apertures, (v) evaluating dose distributions and DVHs, (vi) verifying MU numbers with an independent MU calculation, (vii) transferring beam parameters to the delivery machine, and (viii) verifying all beam parameters including leaf positions with an automatic tool prior to the delivery. The online adaptive replanning system (RealArt, Prowess) was used to perform the steps (ii) - (v). The planning process (steps (ii) to (viii) above) was tested using the CT data of 3 spine and 3 chest cases previously treated with either single or opposing beams for emergency care. Two sample IMRT plans, one for chest, and one for spine, were generated using 9 beams and 45 segments and stored in the Prowess system. The IMRT plan for the spine case was optimized to minimize dose spillage outside the target volume, while the plan for the chest case minimized doses to lung, esophagus and cord. For each of the 3 chest and 3 spine cases, an emergency treatment plan was generated by modifying the corresponding sample plan based on the CT of the case following the above planning process. Results: Generating an emergency RT plan can be completed within 10-20 minutes. Contour generation by the auto-segmentation with manual editing required in the range of 5 - 15 minutes, depending on the degree of manual editing and the number of contours required. Emergency RT plans generated in this way lead to more conformal dose distribution with improved OAR sparing (e.g., 5%-15% reduction in cord max dose) and lower hot spots (reduced by 10%-15%), as compared to those delivered with conventional simple emergency beam configurations. Conclusions: A fast planning system developed originally for online adaptive replanning can be used to generate conformal dosimetric plans for emergency radiation treatments within an acceptable time frame and enabling image-plan-treat in a single patient setup. Author Disclosure: E.E. Ahunbay, None; F.J. Wilson, None; A.X. Li, None.
2853
Whole-brain Radiotherapy in the Treatment of Brain Metastases: A 12-year Analysis of Prognostic Factors and Survival
M. G. Silva1, F. C. Gomes1, E. Y. Saito2, M. A. C. Maia1, J. V. Salvajoli1 1
Hospital A C Camargo, Sao Paulo, Brazil, 2Hospital Aristidez Maltez, Salvador, Brazil
Purpose/Objective(s): To report prognostic factors associated with survival in patients with brain metastases treated with wholebrain radiotherapy (WBRT) in a 12-year period.