Current Practice with Helical
Tomotherapy
in Yonsei University
Jinsil Seong, MD, PhD
Radiation Oncology,
Yonsei University...
Tomotherapy in Yonsei;
• First installment; 2006
• Under Yonsei University Health
System, 3 in Severance, 2 in Gangnam
Sev...
Evaluation for Dosimetric Superiority of
Helical Tomotherapy
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 ...
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...
liver
stomach
kidney, rt
kidney, lt
Less mean dose to
stomach in L-IMRT
(separated lesion
in both lobes and
left lobe lesi...
• HT improves survival in HCC larger
than 5 cm.
• HT-based SBRT is safe and effective
in small HCC while further F/U is
re...
RTOG 1112: Randomized Phase III Study of Sorafenib versus
SBRT followed by Sorafenib in Hepatocellular Carcinoma
S
T
R
A
T...
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Current Practice with Helical Tomotherapy in Yonsei University

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

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Current Practice with Helical Tomotherapy in Yonsei University

  1. 1. 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,
  2. 2. 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
  3. 3. Evaluation for Dosimetric Superiority of Helical Tomotherapy
  4. 4. 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
  5. 5. 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
  6. 6. 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.
  7. 7. • 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
  8. 8. 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

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