current practice with helical tomotherapy in yonsei university

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Current Practice with Helical Tomotherapy in Yonsei University Jinsil Seong, MD, PhD Radiation Oncology, Yonsei University Medical College, Seoul, Korea AERO/KIRAMS/YONSEI Liver Round Table Meeting, Seoul, Korea, 20130531

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Jinsil Seong, MD, PhD Radiation Oncology, Yonsei University Medical College, Seoul, Korea

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Page 1: Current Practice with Helical Tomotherapy in Yonsei University

Current Practice with Helical Tomotherapy in Yonsei University

Jinsil Seong, MD, PhDRadiation Oncology,

Yonsei University Medical College, Seoul, Korea

AERO/KIRAMS/YONSEI Liver Round Table Meeting, Seoul, Korea, 20130531

Page 2: Current Practice with Helical Tomotherapy in Yonsei University

Tomotherapy in Yonsei;

• First installment; 2006• Under Yonsei University Health

System, 3 in Severance, 2 in Gangnam Severance, and 1 in Wonju >> total 6 machines

• No. 1 patients volume

• Tomotherapy for Liver Cancer is not covered by National Health Insurance

Page 3: Current Practice with Helical Tomotherapy in Yonsei University

Evaluation for Dosimetric Superiority of Helical

Tomotherapy

Page 4: Current Practice with Helical Tomotherapy in Yonsei University

Dosimetric Data of 3D-CRT, L-IMRT, & HT

Case Conformity Index

Dose Homo-geneity Index

No. 3D-CRT L-IMRT HT 3D-CRT L-IMRT HT1 2.25 1.14 1.03 1.10 1.06 1.042 2.24 1.15 1.04 1.10 1.06 1.023 1.62 1.16 1.03 1.08 1.06 1.034 1.94 1.18 1.06 1.05 1.06 1.035 1.69 1.23 1.06 1.08 1.05 1.006 1.73 1.17 1.04 1.05 1.06 1.037 6.25 1.15 1.08 1.19 1.06 1.028 2.05 1.21 1.03 1.12 1.05 1.039 1.65 1.48 1.23 1.05 1.08 1.01

10 2.22 2.05 1.11 1.07 1.09 1.0211 1.43 1.34 1.07 1.05 1.08 1.0212 1.48 1.32 1.09 1.09 1.12 1.01

Mean 2.21±1.30 1.30±0.25 1.07 ±0.06 1.09±0.04 1.07 ±0.02 1.02±0.01P-value 0.00 0.00

Page 5: Current Practice with Helical Tomotherapy in Yonsei University

Dosimetric Data of 3D-CRT, L-IMRT, & HT

Organs at risk 3D-CRT L-IMRT HT p value

Remaining liver

Mean dose (Gy) 20.9±6.8 22.57±11.41 24.9±7.6 0.01

V40 (%) 17.8±10.3 29.4±12.1 17.8±13.8 0.04

V50 (%) 11.1±6.7 15.3±7.5 7.6±6.1 0.03

V60 (%) 3.9±3.2 2.1±1.5 0.4±0.3 0.01

Stomach

Mean dose (Gy) 16.1±10.4 22.62±5.72 21.3±6.3 0.11

V40 (%) 10.1±17.3 7.46±11.25 4.6±11.0 0.62

V50 (%) 6.8±13.4 2.61±6.1 2.0±6.0 0.39

V60 (%) 2.7±6.0 0.36±1.14 0.5±1.6 0.24

Page 6: Current Practice with Helical Tomotherapy in Yonsei University

liver

stomach

kidney, rt

kidney, lt

Less mean dose to stomach in L-IMRT

(separated lesion in both lobes and left

lobe lesion)

Higher mean dose to left kidney in right lobe lesion.

Page 7: Current Practice with Helical Tomotherapy in Yonsei University

• HT improves survival in HCC larger than 5 cm.

• HT-based SBRT is safe and effective in small HCC while further F/U is required.

Take Home Message

Page 8: Current Practice with Helical Tomotherapy in Yonsei University

RTOG 1112: Randomized Phase III Study of Sorafenib versus SBRT followed by Sorafenib in Hepatocellular Carcinoma

STRATIFY

Vascular involvement (IVC, main portal vein/right or left main branch portal vein vs. other vascular involvement vs. none)

Hepatitis B vs. C vs. other

North American site vs. Non-North American site

HCC volume/liver volume (<10% vs. 10-40 vs. >40%)

RANDOMIZE

Arm 1 

Daily sorafenib

Arm 2

SBRT alone (27.5 Gy – 50 Gy in 5 fractions)

Followed by

Sorafenib alone daily

• Patients

– Unsuitable for resection or transplant or radiofrequency ablation (RFA)

– Unsuitable for TACE or refractory to TACE

– Barcelona Clinic Liver Cancer Stage (BCLC) Intermediate (B) or Advanced (C)

• LINAC-based, Cyberknife, or protons