Three-dimensional conformal radiation therapy and periodic irradiation with the deep insipration breath-hold technique for hepatocellular carcinoma.

Nine cases of primary hepatocellular carcinoma were treated with 3D-conformal radiation therapy using computerized planning system. This technique permits the precise delivery of a high dose of radiation to the target while sparing most of the normal liver tissue. In order to decrease the effect of organ movement related to respiration, periodical irradiation was combined with the deep inspiration breath-hold technique. The radiation dose was equivalent to conventional radiation with a total dose of 50-70 Gy with 2 Gy, 5 times a week. Irradiation was given in 1-10 fractions which encompassed the target with 90 per cent isodose line. The patients tolerated the treatment procedure well without any complications inherent to the technique. The tumors were decreased in size, the pain symptom and abdominal discomfort were relieved for 3-20 months. This technique is an effective and safe treatment for palliation in hepatocellular carcinoma especially in locally advanced stages with large or multiple lesions. However, long term follow-up should be done to evaluate the late radiation effect and clinical outcome.

Linac based radiosurgery (X-knife) for brain metastases.

Linac based stereotactic radiosurgery by X-knife, technique that permits the precise delivery of a high dose of radiation from 6 MV linear accelerator to intracranial target(s) while sparing the normal tissue, has been used as an alternative treatment for brain metastasis. Five patients with 9 metastatic lesions were treated with this technique. The radiation dose was 15-25 Gy with the 75-80 per cent isodose line encompassing the enhancing tumor according to the tumor volume, site and previous treatment. All metastatic lesions were evaluated at 4 weeks after treatment, there were 2 CR, 4 PR and 3 remained unchanged. The result showed a very distinct clear radiation effect margin between the target and normal tissue. The patient could tolerate the treatment procedure well without any complications inherent to the technique. All patients with neurological symptoms had a satisfactory recuperation. Radiosurgery with X-knife is an effective and safe therapy for brain metastases. It can be applied as a primary treatment, as a booster in combination with whole brain irradiation, or as treatment for patients with relapse in a previous irradiated area.