Prospective Evaluation of Microscopic Extension Using Whole-mount Preparation in Patients with Hepatocellular Carcinoma: Definition of Clinical Target Volume for Radiotherapy

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2010 Aug 25

PMID 20731853

Citations 16

Authors

Weihu Wang

Xiaoli Feng

Tao Zhang

Jing Jin

Shulian Wang

Yueping Liu

Yongwen Song

Xinfan Liu

Zihao Yu

Yexiong Li

Affiliations

Soon will be listed here.

Abstract

Background: To define the clinical target volume (CTV) for radiotherapy in patients with hepatocellular carcinoma (HCC).

Methods: A prospective study was conducted to histologically evaluate the presence and the distance of microscopic extension (ME) for resected HCC on the basis of examination of whole-mount preparations of carcinoma tissue sections.

Results: A total of 380 whole-mount slides prepared from tumor samples of 76 patients with HCC were examined. Patients with elevated pretreatment AFP levels exhibited higher risk of ME as compared to those with normal pretreatment AFP levels (93.9% vs. 69.8%, P < 0.01). ME positivity was 16.7% for Grade 1, 79.1% for Grade 2, and 96.3% for Grade 3 tumors (P < 0.01). The mean distance of ME was 0.0 ± 0.1 mm (range 0-0.2 mm) for Grade 1, 0.9 ± 0.9 mm (range 0-4.5 mm) for Grade 2, and 1.9 ± 1.9 mm (range 0-8.0 mm) for Grade 3 tumors (P < 0.01).

Conclusions: The CTV margins for tumor Grades 1, 2, and 3 HCC, are recommended to be 0.2 mm, 4.5 mm, and 8.0 mm beyond the gross tumor margin, respectively, to account for possible ME of the tumors in all patients.

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References

Giraud P, Antoine M, Larrouy A, Milleron B, Callard P, De Rycke Y . Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning. Int J Radiat Oncol Biol Phys. 2000; 48(4):1015-24. DOI: 10.1016/s0360-3016(00)00750-1. View

Hawkins M, Dawson L . Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer. 2006; 106(8):1653-63. DOI: 10.1002/cncr.21811. View

Ben-Josef E, Normolle D, Ensminger W, Walker S, Tatro D, Ten Haken R . Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2005; 23(34):8739-47. DOI: 10.1200/JCO.2005.01.5354. View

Fukumitsu N, Sugahara S, Nakayama H, Fukuda K, Mizumoto M, Abei M . A prospective study of hypofractionated proton beam therapy for patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2009; 74(3):831-6. DOI: 10.1016/j.ijrobp.2008.10.073. View

Apisarnthanarax S, Elliott D, El-Naggar A, Asper J, Blanco A, Ang K . Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes. Int J Radiat Oncol Biol Phys. 2005; 64(3):678-83. DOI: 10.1016/j.ijrobp.2005.08.020. View

Wheeler T, Dillioglugil O, Kattan M, Arakawa A, Soh S, Suyama K . Clinical and pathological significance of the level and extent of capsular invasion in clinical stage T1-2 prostate cancer. Hum Pathol. 1998; 29(8):856-62. DOI: 10.1016/s0046-8177(98)90457-9. View

Llovet J . Updated treatment approach to hepatocellular carcinoma. J Gastroenterol. 2005; 40(3):225-35. DOI: 10.1007/s00535-005-1566-3. View

Chevret S, Trinchet J, Mathieu D, Rached A, Beaugrand M, Chastang C . A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire. J Hepatol. 1999; 31(1):133-41. DOI: 10.1016/s0168-8278(99)80173-1. View

Park W, Lim D, Paik S, Koh K, Choi M, Park C . Local radiotherapy for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2005; 61(4):1143-50. DOI: 10.1016/j.ijrobp.2004.08.028. View

10.

Hanazaki K, Kajikawa S, Koide N, Adachi W, Amano J . Prognostic factors after hepatic resection for hepatocellular carcinoma with hepatitis C viral infection: univariate and multivariate analysis. Am J Gastroenterol. 2001; 96(4):1243-50. DOI: 10.1111/j.1572-0241.2001.03634.x. View

11.

Wayne J, Lauwers G, Ikai I, Doherty D, Belghiti J, Yamaoka Y . Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg. 2002; 235(5):722-30; discussion 730-1. PMC: 1422499. DOI: 10.1097/00000658-200205000-00015. View

12.

Kim T, Kim D, Park J, Kim Y, Kim S, Park H . Three-dimensional conformal radiotherapy of unresectable hepatocellular carcinoma patients for whom transcatheter arterial chemoembolization was ineffective or unsuitable. Am J Clin Oncol. 2006; 29(6):568-75. DOI: 10.1097/01.coc.0000239147.60196.11. View

13.

Choi T, Edward C, Fan S, Francis P, Wong J . Results of surgical resection for hepatocellular carcinoma. Hepatogastroenterology. 1990; 37(2):172-5. View

14.

Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S . Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003; 38(2):200-7. DOI: 10.1016/s0168-8278(02)00360-4. View

15.

Grills I, Fitch D, Goldstein N, Yan D, Chmielewski G, Welsh R . Clinicopathologic analysis of microscopic extension in lung adenocarcinoma: defining clinical target volume for radiotherapy. Int J Radiat Oncol Biol Phys. 2007; 69(2):334-41. DOI: 10.1016/j.ijrobp.2007.03.023. View

16.

Wang M, Ji Y, Zeng Z, Tang Z, Fan J, Zhou J . Impact factors for microinvasion in patients with hepatocellular carcinoma: possible application to the definition of clinical tumor volume. Int J Radiat Oncol Biol Phys. 2009; 76(2):467-76. DOI: 10.1016/j.ijrobp.2009.01.057. View

17.

Dawson L, McGinn C, Normolle D, Ten Haken R, Walker S, Ensminger W . Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000; 18(11):2210-8. DOI: 10.1200/JCO.2000.18.11.2210. View

18.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M . Cancer statistics, 2009. CA Cancer J Clin. 2009; 59(4):225-49. DOI: 10.3322/caac.20006. View

19.

Carr B, Buch S, Kondragunta V, Pancoska P, Branch R . Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a case cohort study. J Gastroenterol Hepatol. 2008; 23(8 Pt 1):1259-66. DOI: 10.1111/j.1440-1746.2008.05487.x. View

20.

Teh B, Bastasch M, Wheeler T, Mai W, Frolov A, Uhl B . IMRT for prostate cancer: defining target volume based on correlated pathologic volume of disease. Int J Radiat Oncol Biol Phys. 2003; 56(1):184-91. DOI: 10.1016/s0360-3016(03)00085-3. View