title: High dose radiotherapy with image-guided hypo-IMRT for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombi is more feasible and efficacious than conventional 3D-CRT.
abstract: OBJECTIVE
  To compare the efficacies of conventional three-dimensional conformal radiotherapy and image-guided hypofractionated intensity-modulated radiotherapy treatments in advanced hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi.
  
  
  METHODS
  A total of 118 hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi who received external beam radiation therapy focused on tumor thrombi and intrahepatic tumors were retrospectively reviewed. During the three-dimensional conformal radiotherapy treatments, a median total dose of 54 Gy with a conventional fraction (1.8-2.0 Gy/fx) was delivered. During the image-guided hypofractionated intensity-modulated radiotherapy treatments, a median total dose of 60 Gy with fractions of 2.5-4.0 Gy/fx was delivered.
  
  
  RESULTS
  The median follow-up time was 11.8 months (range, 1.7-43.7 months). Higher radiation doses were delivered by image-guided hypofractionated intensity-modulated radiotherapy than by three-dimensional conformal radiotherapy (average dose 57.86 ± 7.03 versus 50.88 ± 6.60 Gy, P ≤ 0.001; average biological effective dose 72.35 ± 9.62 versus 61.45 ± 6.64 Gy, P < 0.001). A longer median survival was found with image-guided hypofractionated intensity-modulated radiotherapy than with three-dimensional conformal radiotherapy (15.47 versus 10.46 months, P = 0.005). Multivariate analysis showed that image-guided hypofractionated intensity-modulated radiotherapy is a significant prognostic factor for overall survival. Toxicity was mild for both image-guided hypofractionated intensity-modulated radiotherapy and three-dimensional conformal radiotherapy.
  
  
  CONCLUSIONS
  High dose radiotherapy delivered by image-guided hypofractionated intensity-modulated radiotherapy appears to be an effective treatment that provides a survival benefit without increasing severe toxicity in hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032.
authors.forename: Jia-Zhou
authors.initials: JZ
authors.lastname: Hou
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032 zeng.zhaochong@zs-hospital.sh.cn.
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032.
authors.forename: Bin-Liang
authors.initials: BL
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032.
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Hui-Fang
authors.initials: HF
authors.lastname: Mo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein / Q000473:pathology; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology
keywords: hepatocellular carcinoma; image-guided; intensity-modulated; radiotherapy