title: Feasibility and efficacy of helical tomotherapy in cirrhotic patients with unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  This study is to evaluate the toxicity and outcomes of helical tomotherapy (HT) in patients treated for unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  From March 2008 to September 2010, 38 patients with unresectable HCC were treated with HT. The median patient age was 67 years (range, 45-85). The median follow-up period was 17.2 months (range, 7-46). All patients had liver cirrhosis. Median radiation dose was 54 Gy (range, 46-71.8) delivered in 1.8 to 2.4-Gy fractions. The planning target volumes were 241.2 ± 153.1 cm(3) (range, 45.8-722.4). Treatment responses were assessed in 3-6 months after HT.
  
  
  RESULTS
  There was a complete response in 2 patients (5.2 %), partial response in 18 patients (47.4 %), stable disease in 13 patients (34.2 %), and progressive disease in 5 patients (13.2 %). The median overall survival was 12.6 months, and 1- and 2-year overall survival rates were 56.2 and 31.7 %, respectively. Eastern Cooperative Oncology Group (ECOG score, p = 0.008), Child-Pugh classification (p = 0.012), albumin (p = 0.046), and hemoglobin (p = 0.028) were significant parameters that predicted primary tumor response to radiotherapy in multivariate analysis. ECOG score (p = 0.012), Child-Pugh class (p = 0.026), and response to radiotherapy (p = 0.016) were independent prognostic factors for overall survival in multivariate analysis. Responders had better overall survival than non-responders (23.6 vs. 5.8 months, p < 0.001). The 1- and 2-year overall survival rates for responders were 68.3 and 57 %, respectively, while for non-responders, they were 0 %. The 1- and 2-year local control rates were 88.2 and 82.3 %, respectively. Five patients (13.2 %) had grade 3 or greater liver toxicity, and one patient (2.6 %) had a grade 3 gastric ulcer. No treatment-related liver failure or death was documented in this study.
  
  
  CONCLUSIONS
  Radiotherapy using HT seems to be a safe and effective treatment option for unresectable HCC patients. This study indicates that HT is a feasible treatment even in patients without good performance status and hepatic function reservation.
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan. 930321@ms.kmuh.org.tw.|Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 930321@ms.kmuh.org.tw.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan. miyihu@kmu.edu.tw.|Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. miyihu@kmu.edu.tw.|Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. miyihu@kmu.edu.tw.
authors.forename: Ming-Yii
authors.initials: MY
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan. reyata@gmail.com.|Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. reyata@gmail.com.
authors.forename: Jen-Yang
authors.initials: JY
authors.lastname: Tang
authors.affiliation: Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. chshch@kmu.edu.tw.|Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. chshch@kmu.edu.tw.
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. liyewa@kmu.edu.tw.|Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. liyewa@kmu.edu.tw.
authors.forename: Liang-Yen
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Division of Hepatobiliary Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 940109@ms.kmuh.org.tw.|Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 940109@ms.kmuh.org.tw.
authors.forename: Zu-Yau
authors.initials: ZY
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan. ccjjhh@kmu.edu.tw.|Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. ccjjhh@kmu.edu.tw.|Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. ccjjhh@kmu.edu.tw.
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000532:radiotherapy*; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D050397:Radiotherapy, Intensity-Modulated; D015996:Survival Rate