Current Practice with Helical Tomotherapy in Yonsei University
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Current Practice with Helical Tomotherapy in Yonsei University

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Jinsil Seong, MD, PhD

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

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Current Practice with Helical Tomotherapy in Yonsei University Current Practice with Helical Tomotherapy in Yonsei University Presentation Transcript

  • 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,
  • 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
  • Evaluation for Dosimetric Superiority of Helical Tomotherapy View slide
  • 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 HT 1 2.25 1.14 1.03 1.10 1.06 1.04 2 2.24 1.15 1.04 1.10 1.06 1.02 3 1.62 1.16 1.03 1.08 1.06 1.03 4 1.94 1.18 1.06 1.05 1.06 1.03 5 1.69 1.23 1.06 1.08 1.05 1.00 6 1.73 1.17 1.04 1.05 1.06 1.03 7 6.25 1.15 1.08 1.19 1.06 1.02 8 2.05 1.21 1.03 1.12 1.05 1.03 9 1.65 1.48 1.23 1.05 1.08 1.01 10 2.22 2.05 1.11 1.07 1.09 1.02 11 1.43 1.34 1.07 1.05 1.08 1.02 12 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±0.01 P-value 0.00 0.00 View slide
  • 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
  • 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.
  • • 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
  • RTOG 1112: Randomized Phase III Study of Sorafenib versus SBRT followed by Sorafenib in Hepatocellular Carcinoma S T R A T I F Y 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%) R A N D O M I Z E 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