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Liver dosimetric evaluation in biologically based stereotactic body radiotherapy for large inoperable hepatocellular carcinoma

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Individualized dose prescription for liver stereotactic body radiotherapy (SBRT) requires effective volume calculation and biological modeling to estimate the risk of liver injury. This study determined dose-volumetric (DV) parameters associated with low risk for radiation-induced liver disease (RILD) derived from normal tissue complication probability (NTCP) modeling with three-fraction and five-fraction SBRT for hepatocellular carcinomas (HCCs) > 5 cm.

Methods

Prescription dose was 24–36 Gy in three fractions and 40–45 Gy in five fractions. Effective volume was determined for 20 liver SBRT plans using the linear-quadratic (LQ) equation. Lyman-Kutcher-Burman NTCP model estimated the risk of liver toxicity. Mean dose to normal liver (MLD) was tabulated from plans associated with < 6 % toxicity prediction. Sensitivity analysis of model parameters and DV relationships to critical volume constraints was performed.

Results

Median normal liver volume was 1144 cm3 (710–2916 cm3) and the median planning target volume (PTV) was 633 cm3 (186–2388 cm3). MLD predicting low hepatic toxicity for three-fraction SBRT plans was 13.8 ± 0.6 Gy, while MLD from five-fraction SBRT plans was 16.1 ± 1.0 Gy. Lower n, α/β, and D 50 parameters and a higher m parameter increased %RILD, and vice versa. An estimated 1200 cm3 of normal liver was needed in 7 of 10 three-fraction plans for very large tumors to functionally preserve 700 cm3and 800 cm3 to ≤ 15 and ≤ 18 Gy, respectively.

Conclusions

MLD values derived for three-fraction and five-fraction SBRT by the NTCP method were consistent with established SBRT liver dose constraints. However, SBRT for large hepatocellular carcinomas may be limited by critical volume dose objectives.

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Acknowledgments

This study was supported by a research grant from Varian Medical Systems.

Conflict of interest

Shaun K. Loewen, Emily Vollans, Catherine Crumley, Hardeep Sahota, Robert Kosztyla, Mitchell Liu, Devin Schellenberg, Marie-Laure Camborde, Cheryl Duzenli, Vitali Moiseenko, Mohamed Khan, and Roy Ma declare that they have no conflict of interest.

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Authors and Affiliations

  1. CancerCare Manitoba—Department of Radiology, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada

    Shaun K. Loewen

  2. British Columbia Cancer Agency, Vancouver, British Columbia, Canada

    Emily Vollans, Catherine Crumley, Hardeep Sahota, Robert Kosztyla, Mitchell Liu, Devin Schellenberg, Marie-Laure Camborde, Cheryl Duzenli, Mohamed Khan & Roy Ma

  3. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA

    Vitali Moiseenko

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  1. Shaun K. Loewen
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Correspondence to Shaun K. Loewen.

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Loewen, S.K., Vollans, E., Crumley, C. et al. Liver dosimetric evaluation in biologically based stereotactic body radiotherapy for large inoperable hepatocellular carcinoma. J Radiat Oncol 4, 177–184 (2015). https://doi.org/10.1007/s13566-015-0195-6

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  • DOI: https://doi.org/10.1007/s13566-015-0195-6

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