RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma.
OBJECTIVE
The goal of this research was to investigate the feasibility of volumetric modulated arc therapy, RapidArc (RA), in association with the active breathing coordinator (ABC) for the treatment of hepatocellular carcinoma (HCC) with radiotherapy.


METHODS
A total of 12 patients with HCC, after receiving transcatheter arterial chemoembolization (TACE) treatment, underwent three-dimensional computer tomography (3D-CT) scanning associated with ABC using end inspiration hold (EIH), end expiration hold (EEH), and free breathing (FB) techniques. The three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and RA plans (three 135° arcs) were designed on different CT images, respectively. The liver volume, gross tumor volume (GTV), and planning target volume (PTV) of the three breath status and the dosimetric differences of the different plans were compared.


RESULTS
There were no significant differences in the volumes of live and GTV between the three breathing techniques (p > 0.05); the PTV in FB was greater than in the EEH and EIH (p < 0.05). The overall conformality index (CI) and homogeneity index (HI) for RA (CI 0.92, HI 0.90) were better than IMRT (CI 0.90, HI 0.89) and 3D-CRT (CI 0.70, HI 0.84) for the three breathing techniques (p< 0.05). The RA and IMRT significantly reduced the mean dose, V(20), V(30), and V(40) of normal liver compared to 3D-CRT, while the V(5) and V(10) in RA were higher than in IMRT. The mean values in mean dose, V(10), V(20), V(30), and V(40) of the normal liver were reduced from 13.12 Gy, 46%, 24%, 13%, and 8% in RA(FB) to 10.23 Gy, 35%, 16%, 8%, and 5% in RA(EEH) and 9.23 Gy, 32%, 16%, 8%, and 5% in RA(EIH ), respectively. In addition, the treatment time of RA was equal to 3D-CRT, which was significantly shorter than IMRT.


CONCLUSIONS
RA in conjunction with ABC for the treatment of HCC with radiotherapy can achieve better dose delivery and ensure the accuracy of the target volume, which spares more organs at risk, uses fewer monitor units, and shortens treatment time.
Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Academy of Medical Sciences, 440 Jiyan Road, 250117, Jinan, China.
G Z
GZ
Gong
Y
Y
Yin
L G
LG
Xing
Y J
YJ
Guo
T
T
Liu
J
J
Chen
J
J
Lu
C
C
Ma
T
T
Sun
T
T
Bai
G
G
Zhang
R
R
Wang
D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D054893:Cone-Beam Computed Tomography; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012119:Respiration; D013997:Time Factors