Application of helical tomotherapy for two cases of advanced hepatocellular carcinoma

Abstract

The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has been limited to date, because the liver has a low tolerance to radiation. However, reconstructing tumors and surrounding organs via a three-dimensional conformal planning system can avoid excess radiotherapy exposure to the rest of the liver and adjacent organs. Recently, the concept of "adaptive radiotherapy," such as with helical tomotherapy, has been introduced for treating HCC. Helical tomotherapy obtains an image from the computed tomography component, which allows targeted regions to be visualized prior to, during, and immediately after each treatment and delivers intensity-modulated radiation therapy. We report two patients with advanced HCC who underwent tomotherapy treatment. One was a patient afflicted with advanced HCC and a portal vein tumor thrombus, which was treated with tomotherapy combined with transarterial chemolipiodolization. The other was a patient afflicted with multiple pulmonary metastases treated with tomotherapy followed by systemic chemotherapy.

Keywords: Carcinoma, hepatocellular; Metastasis; Radiotherapy; Venous thrombosis.

Figure 1

Abdominal computed tomography (CT) scan reveals a diffuse infiltrative hepatocellular carcinoma involving the right hepatic lobe (A) with a portal vein thrombosis (B). Abdominal CT 2 months after transcatheter arterial chemoembolization and tomotherapy showed improvement in the right infiltrative mass (C) and portal vein thrombosis (D). Abdominal CT 6 months after the initial treatment showed partial resolution of the right infiltrative mass (E) and a portal vein thrombosis (F).

Figure 2

Tomotherapy targeting the portal vein tumor thrombosis was administered at a daily dose of 5 Gy for a total dose of 50 Gy.

Figure 3

Chest X-rays show multiple metastatic lung lesions (A). Chest X-ray 2 months (B) and 6 months (C) after tomotherapy showed a marked decrease in the size of the multiple lung nodules. Chest computed tomography (CT) on admission showed multiple metastatic lung lesions with the largest lesion measuring 5.5 cm in diameter (D). Chest CT 2 months later shows a marked decrease in the size of the lung nodules, from 5.5 to 1.3 cm (E). Chest CT 6 months later shows a further decrease in the size of the lung nodules (F).

Figure 4

Tomotherapy was performed with a daily regimen of 3-5 Gy for patients with multiple lung nodules.