title: Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) < 1 cm from gastrointestinal structures, received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 (PTV1) and 2 (PTV2), respectively. The 12 patients in the high dose-fractionation (HD) group, with ITV ≥ 1 cm from gastrointestinal structures, received total doses of 66 and 55 Gy in 22 fractions to the PTV1 and PTV2, respectively.
  
  
  RESULTS
  Overall, treatment was well tolerated, with no grade > 3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7 %) than patients in the HD group (p < 0.05 each). The median overall survival (OS) was 25.1 mKonzept ist machbar und sicheronths and the actuarial 2-year local progression-free survival (LPFS), relapse-free survival (RFS), and OS rates were 67.3, 14.7, and 54.7  %, respectively. The HD group tended to show better tumor response (100 vs. 62.2 %, p = 0.039) and 2-year LPFS (85.7 vs. 59  %, p = 0.119), RFS (38.1 vs. 7.3 %, p = 0.063), and OS (83.3 vs. 44.3 %, p = 0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS.
  
  
  CONCLUSIONS
  SIB-IMRT is feasible and safe for patients with inoperable HCC.
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro Ilsandong-gu, Goyang-si, 410-769, Gyeonggi-do, Republic of Korea.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Yeon-Joo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000379:methods*; D018511:Systems Integration; D016896:Treatment Outcome