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Dose escalation using helical tomotherapy improves local control in spine metastases from primary hepatic malignancies
Author(s) -
Choi Yunseon,
Kim Junwon,
Lee Ikjae,
Seong Jinsil
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12260
Subject(s) - tomotherapy , medicine , hepatocellular carcinoma , radiation therapy , magnetic resonance imaging , nuclear medicine , radiology
Background & Aims This study was designed to reveal the prognostic significance of dose‐escalated radiotherapy with tomotherapy in local control for spine metastases of primary hepatic tumours. Methods From April 2006 to May 2012, 23 hepatocellular carcinoma patients and 7 intrahepatic cholangiocellular carcinoma patients (total 30 patients, 42 spinal lesions) were treated for metastatic spine lesions with helical tomotherapy ( HT ). The gross tumour volume ( GTV ) was defined as a tumour evident from computed tomography and magnetic resonance imaging. Median values were as follows: GTV total dose of 48 Gy (range 21–51), fraction size of 6 Gy (range 3–8) and eight fractions (range 3–17). Pain response was checked according to visual analogue scale (from 0 to 10). Results The median follow‐up was 5.6 months. Six events of local failure occurred, including five lesions in which spinal canals were involved at radiotherapy. Local control rate at 3 months was 86.6%. Biological equivalent dose ( BED ) was correlated with local control ( AUC = 0.833). Higher BED (>56.0 Gy 10 ) was associated with increased local control ( P = 0.004). The median time to local progression in patients receiving ≤56.0 Gy 10 and >56.0 Gy 10 were 3 and 20.8 months respectively. Dose escalation ( BED > 56.0 Gy 10 ) was also associated with improved progression‐free survival (median 14.7 vs. 2.8 months, P = 0.010). Pain reduction was observed in 90.9% (20/22) of patients with painful bone metastases. Conclusions Dose‐escalated radiotherapy ( BED > 56.0 Gy 10 ) using HT improved local control in spinal metastases of hepatic malignancies.