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Preliminary Report of Stereotactic Body Radiation Therapy With Respiratory Motion Tracking for Liver Tumors
Poster Viewing Abstracts S339
Volume 84 Number 3S Supplement 2012 Author Disclosure: S. Cherian: None. T. Djemil: None. M. Abdel-Wahab: None. J. Greskovich: None. J. Fung: None. F. Aucejo: None. C. Miller: None. J. Sanabria: None. N. Menon: None. K. Stephan: None.
Author Disclosure: H. Yoon: None. D. Oh: None. H. Park: None. S. Kang: None. S. Park: None. Y. Han: None.
2322 2321 Dosimetric Analysis of Gastroduodenal Toxicity by Endoscopy in Cirrhotic Patients After Radiation Therapy for Hepatocellular Carcinoma H. Yoon,1 D. Oh,2 H. Park,3 S. Kang,4 S. Park,2,4 and Y. Han3; 1 Sungkyunkwan University, Seoul, Korea, Republic of Korea, 2Samsung Medical Center, Seoul, Korea, Republic of Korea, 3Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, Republic of Korea, 4 Korea University, Seoul, Korea, Republic of Korea Purpose: To identify the dosimetric parameters associated with endoscopic gastroduodenal (GD) toxicity in patients with hepatocellular carcinoma (HCC) treated by radiation therapy (RT). Materials and Methods: We performed esophagogastroduodenoscopy (EGD) before the start of RT and 1 month after the completion of RT when target volume is in close proximity to gastroduodenum as institutional protocol. An additional EGD was performed thereafter, if patients complain of GD symptoms. GD toxicity was evaluated at 6 months after RT by Common Terminology Criteria for Adverse Events (CTCAE 3.0) and the event was defined as grade 2 or higher toxicity. All patients performed 4-dimensional computed tomography (4D-CT) for RT planning. Stomach and duodenum on each respiratory phase were delineated separately and merged together for dosimetric analysis of planning organ at risk volume (PRV) of stomach (S-PRV), and duodenum (D-PRV). The percentage of volume (Vdose) and absolute volume (aVdose) receiving more than the indicated dose were calculated. The receiver operating characteristic (ROC) curve and the area under the receiver operating characteristic curve (AUC) were used to determine the best dosimetric parameter to predict for GD toxicity. Results: A total of 50 patients were enrolled in the current analysis between October 2008 and December 2010. RT was delivered with a median dose of 35 Gy (range, 30- 50 Gy) in 10 fractions. At 6 months, 14 patients (28.0%) experienced grade 2 GD toxicity and 7 patients (14.0%) experienced grade 3 GD toxicity. For duodenumV30 and aV30 were the most predictive factors. Duodenal toxicity rate at 6 months was 15.2% vs. 64.7% for V30 26% and V30 > 26% and 13.8% vs. 57.14% for aV30 11 cc and aV30 > 11 cc, respectively. For stomach, V25 and aV25 were the most predictive factors. Gastric toxicity rate at 6 months was 5.4% vs. 84.6% for V25 6.5% and V25 > 6.5% and 0% vs. 61.9% for aV25 6 cc and aV25 > 6 cc, respectively (Table). Conclusion: V30 for duodenum and V25 for stomach can be predictive factors for endoscopic GD toxicity in cirrhotic patients with HCC treated by RT.
Poster Viewing Abstract 2321; Table operating characteristic (ROC) curve
Dosimetric analysis by the receiver
S-PRV Cutoff Parameter point V15 V20 V25 V30 aV15 aV20 aV25 aV30
4.06 9.31 6.45 1.38 11.9 13.5 5.97 3.47
100/70.3 84.6/89.2 84.6/94.6 92.3/86.5 100/67.6 92.3/78.4 100/78.4 92.3/83.8
0.892 0.906 0.946 0.92 0.873 0.898 0.942 0.923
0.003 0.003 0.003 0.054 0.007 0.004 0.003 0.068
24.57 26.53 14.19 11.97 22.66 20.28 14.48 11.15
Sensitivity/ p specificity AUC value 87.5/52.9 81.2/67.6 81.2/64.7 81.2/73.5 81.2/55.9 81.2/64.7 81.2/64.7 75.0/76.5
Purpose/Objective(s): To investigate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) with real-time respiratory motion tracking for primary or metastatic liver tumors. Materials/Methods: Seventeen patients, who underwent SBRT between April 2010 and February 2012 using robotic radiosurgery, were followed up. In the selected patients, 14 patients (16 lesions) were diagnosed with primary liver tumors, and other 3 patients (4 lesions) with metastatic liver tumors. All the patients were received tumor-tracking SBRT treatments under the effectively same treatment condition. The patients treatment plans were designed with four-dimensional dynamic dose delivery technique based on the four-dimensional CT dataset with proper respiration modeling. The 45 Gy prescribed dose were delivered to planned target volume (PTV) throughout 3 fractionations with every other day treatment scheme. The PTV was delineated with 5-mm extent from gross tumor volume, which was drawn based on fused CT and MR image sets. To achieve both adequate target coverage and normal tissue sparing, we carefully designed the treatment plan that the prescribed isodose line covered entire GTV and at least 95% of PTV volumes, respectively, whereas the normal liver volume receiving 19 Gy did not exceed 700 cc. Tumor response after irradiations was evaluated based on the RECIST criteria and treatment toxicity was estimated according to the Common Toxicity Criteria (CTC) guidelines version 3.0. Results: All patients were evaluated based on follow-up images with median follow-up period of 13 months (range, 1-21 months). We observed clear tumor response after SBRT in all patient group. That is, complete response was shown in 45% of treatment lesions (9/20 lesions), partial response was in 40% (8/20 lesions), and stable disease was shown in 15% (3/20 lesions). Three of 17 (17.7%) patients experienced acute toxicities including nausea in 1 and fatigue in 2 patients, respectively, but they were only limited in Grade 1. No higher grade acute toxicity was observed. Conclusions: Our clinical data of SBRT for small liver tumors showed relatively better local control probability with less occurring of acute toxicity. Therefore, although the long-term follow-up must be needed to firmly prove the clinical efficacy, the SBRT with real-time respiratory motion tracking could be considered as a strong alternative to surgical operation for small liver tumors. Author Disclosure: K. Kang: None. Y. Lim: None. H. Jeong: None. I. Ha: None. B. Jeong: None. H. Jang: None. B. Choi: None. G. Chai: None.
2323
D-PRV
Cutoff Sensitivity/ p specificity AUC value point
Preliminary Report of Stereotactic Body Radiation Therapy With Respiratory Motion Tracking for Liver Tumors K. Kang,1 Y. Lim,2 H. Jeong,1 I. Ha,1 B. Jeong,1 H. Jang,3 B. Choi,3 and G. Chai1; 1Gyeonsang National University Hospital, Jinju, Korea, Republic of Korea, 2National Cancer Center, Goyang, Korea, Republic of Korea, 3Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of Korea
0.686 0.710 0.746 0.820 0.676 0.719 0.741 0.805
0.003 0.003 0.003 0.054 0.007 0.004 0.003 0.068
Abbreviations: Vdose, the percentage of volume receiving more than the indicated dose (%); aVdose, absolute volume receiving more than the indicated dose (cc); PRV, planning organ at risk volume; S, Stomach; D, Duodenum, AUC; the area under the ROC curve
Efficacy of Radioembolization Treatments With Yttrium-90 Microspheres for Hepatocellular Carcinoma and Liver Metastases M.A. Ziegler,1 R. Kumar,1 A.T. Wild,1 T.M. Pawlik,2 I.R. Kamel,3 J.M. Herman,1 and J.H. Geschwind4; 1Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, 2Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, 3Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, 4Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD
Volume 84 Number 3S Supplement 2012 Author Disclosure: S. Cherian: None. T. Djemil: None. M. Abdel-Wahab: None. J. Greskovich: None. J. Fung: None. F. Aucejo: None. C. Miller: None. J. Sanabria: None. N. Menon: None. K. Stephan: None.
Author Disclosure: H. Yoon: None. D. Oh: None. H. Park: None. S. Kang: None. S. Park: None. Y. Han: None.
2322 2321 Dosimetric Analysis of Gastroduodenal Toxicity by Endoscopy in Cirrhotic Patients After Radiation Therapy for Hepatocellular Carcinoma H. Yoon,1 D. Oh,2 H. Park,3 S. Kang,4 S. Park,2,4 and Y. Han3; 1 Sungkyunkwan University, Seoul, Korea, Republic of Korea, 2Samsung Medical Center, Seoul, Korea, Republic of Korea, 3Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, Republic of Korea, 4 Korea University, Seoul, Korea, Republic of Korea Purpose: To identify the dosimetric parameters associated with endoscopic gastroduodenal (GD) toxicity in patients with hepatocellular carcinoma (HCC) treated by radiation therapy (RT). Materials and Methods: We performed esophagogastroduodenoscopy (EGD) before the start of RT and 1 month after the completion of RT when target volume is in close proximity to gastroduodenum as institutional protocol. An additional EGD was performed thereafter, if patients complain of GD symptoms. GD toxicity was evaluated at 6 months after RT by Common Terminology Criteria for Adverse Events (CTCAE 3.0) and the event was defined as grade 2 or higher toxicity. All patients performed 4-dimensional computed tomography (4D-CT) for RT planning. Stomach and duodenum on each respiratory phase were delineated separately and merged together for dosimetric analysis of planning organ at risk volume (PRV) of stomach (S-PRV), and duodenum (D-PRV). The percentage of volume (Vdose) and absolute volume (aVdose) receiving more than the indicated dose were calculated. The receiver operating characteristic (ROC) curve and the area under the receiver operating characteristic curve (AUC) were used to determine the best dosimetric parameter to predict for GD toxicity. Results: A total of 50 patients were enrolled in the current analysis between October 2008 and December 2010. RT was delivered with a median dose of 35 Gy (range, 30- 50 Gy) in 10 fractions. At 6 months, 14 patients (28.0%) experienced grade 2 GD toxicity and 7 patients (14.0%) experienced grade 3 GD toxicity. For duodenumV30 and aV30 were the most predictive factors. Duodenal toxicity rate at 6 months was 15.2% vs. 64.7% for V30 26% and V30 > 26% and 13.8% vs. 57.14% for aV30 11 cc and aV30 > 11 cc, respectively. For stomach, V25 and aV25 were the most predictive factors. Gastric toxicity rate at 6 months was 5.4% vs. 84.6% for V25 6.5% and V25 > 6.5% and 0% vs. 61.9% for aV25 6 cc and aV25 > 6 cc, respectively (Table). Conclusion: V30 for duodenum and V25 for stomach can be predictive factors for endoscopic GD toxicity in cirrhotic patients with HCC treated by RT.
Poster Viewing Abstract 2321; Table operating characteristic (ROC) curve
Dosimetric analysis by the receiver
S-PRV Cutoff Parameter point V15 V20 V25 V30 aV15 aV20 aV25 aV30
4.06 9.31 6.45 1.38 11.9 13.5 5.97 3.47
100/70.3 84.6/89.2 84.6/94.6 92.3/86.5 100/67.6 92.3/78.4 100/78.4 92.3/83.8
0.892 0.906 0.946 0.92 0.873 0.898 0.942 0.923
0.003 0.003 0.003 0.054 0.007 0.004 0.003 0.068
24.57 26.53 14.19 11.97 22.66 20.28 14.48 11.15
Sensitivity/ p specificity AUC value 87.5/52.9 81.2/67.6 81.2/64.7 81.2/73.5 81.2/55.9 81.2/64.7 81.2/64.7 75.0/76.5
Purpose/Objective(s): To investigate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) with real-time respiratory motion tracking for primary or metastatic liver tumors. Materials/Methods: Seventeen patients, who underwent SBRT between April 2010 and February 2012 using robotic radiosurgery, were followed up. In the selected patients, 14 patients (16 lesions) were diagnosed with primary liver tumors, and other 3 patients (4 lesions) with metastatic liver tumors. All the patients were received tumor-tracking SBRT treatments under the effectively same treatment condition. The patients treatment plans were designed with four-dimensional dynamic dose delivery technique based on the four-dimensional CT dataset with proper respiration modeling. The 45 Gy prescribed dose were delivered to planned target volume (PTV) throughout 3 fractionations with every other day treatment scheme. The PTV was delineated with 5-mm extent from gross tumor volume, which was drawn based on fused CT and MR image sets. To achieve both adequate target coverage and normal tissue sparing, we carefully designed the treatment plan that the prescribed isodose line covered entire GTV and at least 95% of PTV volumes, respectively, whereas the normal liver volume receiving 19 Gy did not exceed 700 cc. Tumor response after irradiations was evaluated based on the RECIST criteria and treatment toxicity was estimated according to the Common Toxicity Criteria (CTC) guidelines version 3.0. Results: All patients were evaluated based on follow-up images with median follow-up period of 13 months (range, 1-21 months). We observed clear tumor response after SBRT in all patient group. That is, complete response was shown in 45% of treatment lesions (9/20 lesions), partial response was in 40% (8/20 lesions), and stable disease was shown in 15% (3/20 lesions). Three of 17 (17.7%) patients experienced acute toxicities including nausea in 1 and fatigue in 2 patients, respectively, but they were only limited in Grade 1. No higher grade acute toxicity was observed. Conclusions: Our clinical data of SBRT for small liver tumors showed relatively better local control probability with less occurring of acute toxicity. Therefore, although the long-term follow-up must be needed to firmly prove the clinical efficacy, the SBRT with real-time respiratory motion tracking could be considered as a strong alternative to surgical operation for small liver tumors. Author Disclosure: K. Kang: None. Y. Lim: None. H. Jeong: None. I. Ha: None. B. Jeong: None. H. Jang: None. B. Choi: None. G. Chai: None.
2323
D-PRV
Cutoff Sensitivity/ p specificity AUC value point
Preliminary Report of Stereotactic Body Radiation Therapy With Respiratory Motion Tracking for Liver Tumors K. Kang,1 Y. Lim,2 H. Jeong,1 I. Ha,1 B. Jeong,1 H. Jang,3 B. Choi,3 and G. Chai1; 1Gyeonsang National University Hospital, Jinju, Korea, Republic of Korea, 2National Cancer Center, Goyang, Korea, Republic of Korea, 3Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of Korea
0.686 0.710 0.746 0.820 0.676 0.719 0.741 0.805
0.003 0.003 0.003 0.054 0.007 0.004 0.003 0.068
Abbreviations: Vdose, the percentage of volume receiving more than the indicated dose (%); aVdose, absolute volume receiving more than the indicated dose (cc); PRV, planning organ at risk volume; S, Stomach; D, Duodenum, AUC; the area under the ROC curve
Efficacy of Radioembolization Treatments With Yttrium-90 Microspheres for Hepatocellular Carcinoma and Liver Metastases M.A. Ziegler,1 R. Kumar,1 A.T. Wild,1 T.M. Pawlik,2 I.R. Kamel,3 J.M. Herman,1 and J.H. Geschwind4; 1Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, 2Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, 3Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, 4Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD