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

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. 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. Evaluation for Dosimetric Superiority of
Helical Tomotherapy

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. 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. 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. • 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. 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