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Stereotactic Body Radiation Therapy Using a Real-time Tumor-Tracking Radiation Therapy System for Hepatocellular Carcinomas
Poster Viewing E155
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) can treat hepatocellular (HCC) patients who are not eligible for surgery, transarterial chemoembolization, or radiofrequency ablation. This study aims to compare the efficacy and toxicity of SBRT to small tumors (< 4.4cm, our median population size) and moderate to large tumors ( 4.4cm). Materials/Methods: A retrospective study of the first 48 provincially treated HCC patients (March 2011 -July 2015) was conducted. All patients were discussed at multidisciplinary rounds and considered ineligible for further standard local therapies. Local control (LC), progression free survival (PFS), overall survival (OS) and toxicities were analyzed. Results: Fifty-one separate hepatomas were treated with a median size of 4.4cm (range: 1.3-15.6cm). Baseline demographics, performance status, previous liver-directed treatments, and Child’s Pugh (CP) score were similar between the groups. Hepatitis B was more common in the 4.4cm group while Hepatitis C was more common in the <4.4cm group (P Z 0.05). RT doses were 36 to 50 Gy in three to 10 fractions, with 87% of patients receiving 45 Gy in 3 or 5 fractions. Twenty-eight (55%) hepatomas were treated with a biological equivalent dose (BED10) 100 Gy and 45 (88.3%) were treated with a BED10 80 Gy. Tumors <4.4cm were more likely to be treated with a BED10 80 Gy (P<0.001). Seven patients (15%) had worsened CP score by >1 point at 3 months post SBRT, but this was not different between the two groups (P Z 0.86). LC for all patients was 94% at 1 and 2 years, and was comparable for tumors <4.4cm and 4.4cm (2 year LC: 96% for <4.4cm vs 92% for 4.4cm, P Z 0.91). OS for all patients was 65% at 2 years (87% for <4.4cm vs 46% for 4.4cm, P Z 0.07). PFS was 38% at 2 years for all patients, and did not differ significantly between groups (P Z 0.70). On univariate analysis, BED10 80 Gy was the only factor associated with improved PFS, while both BED10 80 Gy and normal baseline AFP were associated with improved OS. Conclusion: SBRT provides high local control for patients with inoperable HCC and can be delivered with acceptable risk for post-treatment hepatic injury even for moderate to large sized tumors. Radiation doses above BED10 of 80 Gy improved PFS and OS in our cohort. Author Disclosure: R. Yeung: None. T.P. Rackley: None. B. Webber: None. J. Hamm: None. R. Lee: None. M. Camborde: None. M. Pearson: None. C.R. Duzenli: None. S.K. Loewen: None. M. Liu: None. R. Ma: None. D. Schellenberg: Research Grant; Varian. Honoraria; Varian.
was from 6 to 40 mm with a median of 20 mm. Before the SBRT, 30 patients were evaluated as Child -Pugh class A, 4 as class B, and the status of 3 patients is unknown because of insufficient data. Among the 37 patients, four had two lesions and one patient had four lesions. The remaining thirty-two patients had a solitary lesion. All of the multiple lesions were closely located and encompassed by a single planning target volume (PTV). Thirty-four patients received 48 Gy in 8 fractions, 2 received 35 Gy in 4 fractions, and 1 received 40 Gy in 4 fractions. The tumor responses were evaluated based on the modified Response Evaluation Criteria in Solid Tumors and the toxicities were assessed based on the Common Terminology Criteria for Adverse Events version 4.03. Local failure was defined as tumor recurrence within the PTV and the local control (LC) rate was defined as the absence of local failure. Both the overall survival (OS) and LC rates were calculated from the starting date of the SBRT according to the Kaplan-Meier method. Results: The median follow-up period was 17 months (range: 2 e 82). No patients experienced grade 3 or higher complications due to the implantation of the fiducial marker. The 1-year and 2-year OS rates were 82% and 71%, respectively, and the LC rates were 100% and 89%. Grade 3 or higher elevations of the level of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) was observed in three patients (8.1%) within 6 months of the treatment. Two of these three patients underwent RFA or TACE for intrahepatic new lesions within 6 months of the SBRT. One patient with dermatomyositis showed grade 4 AST/ALT elevations. No severe gastrointestinal toxicities were observed. Conclusion: The SBRT using the RTRT system for patients with HCC who were ineligible for surgery, local ablative therapies or TACE was effective with low incidence of severe toxicity. Author Disclosure: Y. Uchinami: None. N. Katoh: None. D. Abo: None. K. Harada: None. T. Inoue: None. H. Taguchi: None. R. Onimaru: None. S. Shimizu: None. Y. Sakuhara: None. K. Ogawa: None. T. Kamiyama: None. H. Shirato: Research Grant; Hitachi, Ltd., Mitsubishi Heavy Industries, Ltd., Shimadzu Corporation. Patent/License Fees/ Copyright; US 6307914 B1.
2379 Withdrawn
2378 Stereotactic Body Radiation Therapy Using a Real-time Tumor-Tracking Radiation Therapy System for Hepatocellular Carcinomas Y. Uchinami,1 N. Katoh,2 D. Abo,2 K. Harada,2 T. Inoue,2 H. Taguchi,3 R. Onimaru,1 S. Shimizu,1,4 Y. Sakuhara,2 K. Ogawa,2 T. Kamiyama,2 and H. Shirato1,4; 1Hokkaido University Graduate School of Medicine, Sapporo, Japan, 2Hokkaido University Hospital, Sapporo, Japan, 3Obihiro Kosei Hospital, Obihiro, Japan, 4Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan Purpose/Objective(s): A real-time tumor-tracking radiation therapy (RTRT) system enables gated radiation therapy where the therapeutic beam is delivered only when an implanted fiducial marker near the tumor is within 2-mm of the planned position. The aim of this study is to evaluate the outcomes and toxicities with stereotactic body radiation therapy (SBRT) using the RTRT system for HCC, where other therapies are not available. Materials/Methods: We conducted a retrospective review of the medical records of patients with HCC treated by SBRT using RTRT system in our institution from January 2005 to December 2015. Inclusion criteria were: curative SBRT delivered using the RTRT system; no vascular or bile duct invasion on contrast enhanced CT or MR images; and no extrahepatic metastases, and the review identified 37 patients (26 male and 11 female) with 44 lesions. All of these patients were considered to be ineligible for surgery, local ablative therapies such as radio-frequency ablation (RFA) or transarterial chemoembolization (TACE), or refractory to TACE. The median age was 68 years (range: 54e84). The maximum tumor diameter
2380 Planning Target Volume Margin Definition From Image Guided Hypofractionated Radiation Therapy for Pancreatic Cancer J. Wang, J. Xie, S.P. Xu, C.B. Xie, H.S. Gong, X.S. Wang, and B.L. Qu; Chinese PLA General Hospital & Medical Academy, Beijing, China Purpose/Objective(s): The hypothesis is that the precise definition of planning target volume (PTV) may contribute to tumor local control and reduce risk of treatment-related complications for pancreatic cancer. PTV margins were evaluated from image guided hypofractionated radiation therapy of pancreatic cancer in a prospective study. Materials/Methods: Forty-three pancreatic cancer patients received hypofractionated image guided and intensity modulated radiation therapy (IG-IMRT) with 54-65 Gy in 17-33 fractions. All underwent body plate fixation, time- sharing oral contrast agents and kilovoltage (KV) computed tomography (CT) simulation. The delineation of gross target volume (GTV) was contoured using fused CT contrast images. Clinical target volume (CTV) was contoured according to GTV and its suspected involved field or drainage area. PTV included GTV and CTV with a margin of 510mm for axial plane and 10-20mm for longitude plane without protruding intestinal lumen and stomach. Image guide and correction of therapeutic target area were conducted using precise resolution and bone registration when comparing megavoltage (MV) fan-beam CT scans to prior KV CT images. Means and standard deviations (SDs) for each shift and rotation were calculated. PTV margins and its related factors were evaluated and analyzed.
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) can treat hepatocellular (HCC) patients who are not eligible for surgery, transarterial chemoembolization, or radiofrequency ablation. This study aims to compare the efficacy and toxicity of SBRT to small tumors (< 4.4cm, our median population size) and moderate to large tumors ( 4.4cm). Materials/Methods: A retrospective study of the first 48 provincially treated HCC patients (March 2011 -July 2015) was conducted. All patients were discussed at multidisciplinary rounds and considered ineligible for further standard local therapies. Local control (LC), progression free survival (PFS), overall survival (OS) and toxicities were analyzed. Results: Fifty-one separate hepatomas were treated with a median size of 4.4cm (range: 1.3-15.6cm). Baseline demographics, performance status, previous liver-directed treatments, and Child’s Pugh (CP) score were similar between the groups. Hepatitis B was more common in the 4.4cm group while Hepatitis C was more common in the <4.4cm group (P Z 0.05). RT doses were 36 to 50 Gy in three to 10 fractions, with 87% of patients receiving 45 Gy in 3 or 5 fractions. Twenty-eight (55%) hepatomas were treated with a biological equivalent dose (BED10) 100 Gy and 45 (88.3%) were treated with a BED10 80 Gy. Tumors <4.4cm were more likely to be treated with a BED10 80 Gy (P<0.001). Seven patients (15%) had worsened CP score by >1 point at 3 months post SBRT, but this was not different between the two groups (P Z 0.86). LC for all patients was 94% at 1 and 2 years, and was comparable for tumors <4.4cm and 4.4cm (2 year LC: 96% for <4.4cm vs 92% for 4.4cm, P Z 0.91). OS for all patients was 65% at 2 years (87% for <4.4cm vs 46% for 4.4cm, P Z 0.07). PFS was 38% at 2 years for all patients, and did not differ significantly between groups (P Z 0.70). On univariate analysis, BED10 80 Gy was the only factor associated with improved PFS, while both BED10 80 Gy and normal baseline AFP were associated with improved OS. Conclusion: SBRT provides high local control for patients with inoperable HCC and can be delivered with acceptable risk for post-treatment hepatic injury even for moderate to large sized tumors. Radiation doses above BED10 of 80 Gy improved PFS and OS in our cohort. Author Disclosure: R. Yeung: None. T.P. Rackley: None. B. Webber: None. J. Hamm: None. R. Lee: None. M. Camborde: None. M. Pearson: None. C.R. Duzenli: None. S.K. Loewen: None. M. Liu: None. R. Ma: None. D. Schellenberg: Research Grant; Varian. Honoraria; Varian.
was from 6 to 40 mm with a median of 20 mm. Before the SBRT, 30 patients were evaluated as Child -Pugh class A, 4 as class B, and the status of 3 patients is unknown because of insufficient data. Among the 37 patients, four had two lesions and one patient had four lesions. The remaining thirty-two patients had a solitary lesion. All of the multiple lesions were closely located and encompassed by a single planning target volume (PTV). Thirty-four patients received 48 Gy in 8 fractions, 2 received 35 Gy in 4 fractions, and 1 received 40 Gy in 4 fractions. The tumor responses were evaluated based on the modified Response Evaluation Criteria in Solid Tumors and the toxicities were assessed based on the Common Terminology Criteria for Adverse Events version 4.03. Local failure was defined as tumor recurrence within the PTV and the local control (LC) rate was defined as the absence of local failure. Both the overall survival (OS) and LC rates were calculated from the starting date of the SBRT according to the Kaplan-Meier method. Results: The median follow-up period was 17 months (range: 2 e 82). No patients experienced grade 3 or higher complications due to the implantation of the fiducial marker. The 1-year and 2-year OS rates were 82% and 71%, respectively, and the LC rates were 100% and 89%. Grade 3 or higher elevations of the level of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) was observed in three patients (8.1%) within 6 months of the treatment. Two of these three patients underwent RFA or TACE for intrahepatic new lesions within 6 months of the SBRT. One patient with dermatomyositis showed grade 4 AST/ALT elevations. No severe gastrointestinal toxicities were observed. Conclusion: The SBRT using the RTRT system for patients with HCC who were ineligible for surgery, local ablative therapies or TACE was effective with low incidence of severe toxicity. Author Disclosure: Y. Uchinami: None. N. Katoh: None. D. Abo: None. K. Harada: None. T. Inoue: None. H. Taguchi: None. R. Onimaru: None. S. Shimizu: None. Y. Sakuhara: None. K. Ogawa: None. T. Kamiyama: None. H. Shirato: Research Grant; Hitachi, Ltd., Mitsubishi Heavy Industries, Ltd., Shimadzu Corporation. Patent/License Fees/ Copyright; US 6307914 B1.
2379 Withdrawn
2378 Stereotactic Body Radiation Therapy Using a Real-time Tumor-Tracking Radiation Therapy System for Hepatocellular Carcinomas Y. Uchinami,1 N. Katoh,2 D. Abo,2 K. Harada,2 T. Inoue,2 H. Taguchi,3 R. Onimaru,1 S. Shimizu,1,4 Y. Sakuhara,2 K. Ogawa,2 T. Kamiyama,2 and H. Shirato1,4; 1Hokkaido University Graduate School of Medicine, Sapporo, Japan, 2Hokkaido University Hospital, Sapporo, Japan, 3Obihiro Kosei Hospital, Obihiro, Japan, 4Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan Purpose/Objective(s): A real-time tumor-tracking radiation therapy (RTRT) system enables gated radiation therapy where the therapeutic beam is delivered only when an implanted fiducial marker near the tumor is within 2-mm of the planned position. The aim of this study is to evaluate the outcomes and toxicities with stereotactic body radiation therapy (SBRT) using the RTRT system for HCC, where other therapies are not available. Materials/Methods: We conducted a retrospective review of the medical records of patients with HCC treated by SBRT using RTRT system in our institution from January 2005 to December 2015. Inclusion criteria were: curative SBRT delivered using the RTRT system; no vascular or bile duct invasion on contrast enhanced CT or MR images; and no extrahepatic metastases, and the review identified 37 patients (26 male and 11 female) with 44 lesions. All of these patients were considered to be ineligible for surgery, local ablative therapies such as radio-frequency ablation (RFA) or transarterial chemoembolization (TACE), or refractory to TACE. The median age was 68 years (range: 54e84). The maximum tumor diameter
2380 Planning Target Volume Margin Definition From Image Guided Hypofractionated Radiation Therapy for Pancreatic Cancer J. Wang, J. Xie, S.P. Xu, C.B. Xie, H.S. Gong, X.S. Wang, and B.L. Qu; Chinese PLA General Hospital & Medical Academy, Beijing, China Purpose/Objective(s): The hypothesis is that the precise definition of planning target volume (PTV) may contribute to tumor local control and reduce risk of treatment-related complications for pancreatic cancer. PTV margins were evaluated from image guided hypofractionated radiation therapy of pancreatic cancer in a prospective study. Materials/Methods: Forty-three pancreatic cancer patients received hypofractionated image guided and intensity modulated radiation therapy (IG-IMRT) with 54-65 Gy in 17-33 fractions. All underwent body plate fixation, time- sharing oral contrast agents and kilovoltage (KV) computed tomography (CT) simulation. The delineation of gross target volume (GTV) was contoured using fused CT contrast images. Clinical target volume (CTV) was contoured according to GTV and its suspected involved field or drainage area. PTV included GTV and CTV with a margin of 510mm for axial plane and 10-20mm for longitude plane without protruding intestinal lumen and stomach. Image guide and correction of therapeutic target area were conducted using precise resolution and bone registration when comparing megavoltage (MV) fan-beam CT scans to prior KV CT images. Means and standard deviations (SDs) for each shift and rotation were calculated. PTV margins and its related factors were evaluated and analyzed.