ABSTRACT
BACKGROUND AND PURPOSE: External beam radiation therapy with concurrent chemotherapy (CRT) is widely used for the treatment of unresectable pancreatic cancer. Noncoplanar (NCP) 3D conformal radiotherapy (3DCRT) and coplanar (CP) IMRT have been reported to lower the radiation dose to organs at risk (OARs). The purpose of this article is to examine the utility of noncoplanar beam angles in IMRT for the management of pancreatic cancer. MATERIALS AND METHODS: Sixteen patients who were treated with CRT for unresectable adenocarcinoma of the pancreatic head or neck were re-planned using CP and NCP beams in 3DCRT and IMRT with the Varian Eclipse treatment planning system. RESULTS: Compared to CP IMRT, NCP IMRT had similar target coverage with slightly increased maximum point dose, 5,799 versus 5,775 cGy (p = 0.008). NCP IMRT resulted in lower mean kidney dose, 787 versus 1,210 cGy (p < 0.0001) and higher mean liver dose, 1,208 versus 1,061 cGy (p < 0.0001). Also, NCP IMRT resulted in similar mean stomach dose, 1,257 versus 1,248 cGy (p = 0.86) but slightly higher mean small bowel dose, 981 versus 866 cGy (p < 0.0001). CONCLUSIONS: The NCP IMRT was able to significantly decrease bilateral kidney dose, but did not improve other dose-volume criteria. The use of NCP beam angles is preferred only in patients with risk factors for treatment-related kidney dysfunction.
Subject(s)
Adenocarcinoma/radiotherapy , Pancreatic Neoplasms/radiotherapy , Radiotherapy, Intensity-Modulated/instrumentation , Radiotherapy, Intensity-Modulated/methods , Algorithms , Humans , Kidney/radiation effects , Organs at Risk , Radiometry/methods , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted/methods , Risk FactorsABSTRACT
Hepatocellular carcinoma (HCC) is the most frequently occurring primary tumour of the liver in adults and the third most common cause of cancer-related deaths in the world. The incidence of HCC is increasing both in Europe and in the United States due to the increasing prevalence of hepatitis C. Of recognised importance, when making decisions regarding the most appropriate management of a patient with HCC, is the involvement of a multidisciplinary team of hepatologists, hepatobiliary surgeons, a liver transplant team, interventional radiologists, and medical and radiation oncologists. This manuscript reviews the role of stereotactic body radiotherapy in HCC.