Study On Primary Hepatic Carcinoma Of CTV

Primary Hepatic Carcinoma, which is kinds of cancer from liver cells or bile duct cells, the mortality, is third in digestive system. Therefore, it is a frequent tumor in China. More and more people were interested in radiation therapy in hepatic cancer; as a result, patients were treated by all- exposure, local-exposure, all liver moving strip exposure and hyper fractionation exposure until the middle of 1990s. Three-Dimensional conformal radiotherapy began to use in cancer therapy, and tend to be a important way to radiation therapy in hepatic cancer. The target regions including in Gross tumor volume (GTV), Clinical target volume (CTV), Planning target volume (PTV). ICRU defined GTV in target regions as followed: GTV is tumor volume as seen in the clinical examination or iconography. It is very important for success of cure to sketch GTV accurately. Purdy group showed that if tumor target regions sketched were smaller than genuine, which may cause to injury to normal organism; conversely, the result will make patients disappointed because of the loss of control or recurrence. In 3D radiotherapy planning system, determination of target regions is the key point to cure the tumor, exactly, determination of GTV is key point for determination of target regions.Clinical target volume(CTV) is elongation regions to GTV, including inferior clinic lesion and diffusion regions possible. CTV is inferior clinic lesion mainly for Primary Hepatic Carcinoma. It is a problem for physician to definite the distance between CTV and GTV. In work, many medical institutions definite the extent by their experience.So far, the imagery technology of directly determining the tiny imbibitions has not been available. It largely depends on doctor's knowledge about the tumor biology and clinic experience. Therefore, more recent studies have concentrated on detecting the exact scope CTV of 3D-CRT. Literature surveys yield little reports on the CTV and GTV scope of hepatic carcinoma. One of the challenges lies in the pathology specimen of CTV, which is hard to obtain after the target area for patient is performed. And the images of ultrasonic medicine or CT or MRI can not be well related with those of pathology specimen. Additionally, the accuracy of CTV is ambiguously checked. The present study by means of pathomorphology method has dealt with a promising way for the problems.Objective: The aim of the study was analysised the relationship between the distance of imbibition and pathology parameter ,by the research of the relationship between imbibition areas and pathology;the measurement of the distance of imbibition of hepatic carcinoma sample in three-dimension, then pick up CTV.therefore, this study may supply the evidence for sketching the target areas of Primary hepatic carcinoma in the process of radiation therapy. Methods:1,Cases of data collection: All the case in 2005 to 2008 from People's Armed Police General Hospital hepatobiliary surgical resection specimens of 42 cases of primary liver cancer were confirmed by pathology of primary liver cancer, the patient did not receive preoperative radiotherapy and chemotherapy. Of these, 40 cases of male patients, two cases of women; the age distribution of 32-73 years old, the average age of 56-year-old. Selected specimens were intrahepatic tumor nodule, tumor diameter, from 2cm to 9.7cm, the average of 4.7cm. Pathological classification of six cases of well-differentiated hepatocellular carcinoma, 23 cases of moderately differentiated, poorly differentiated 10 cases; three cases of cholangiocarcinoma.2,42 cases of HCC specimens made of serial sections, observed under an optical microscope, looking for small and large tumor infiltration outside the kitchen, using image analysis system deal with small infiltrating lesions measuring from the gross tumor border maximum distance and to identify subsets of liver tumor the scope of clinical lesions.Results:In the 42 samples, microinvasion did not exist near the liver tumor in the 6 samples of them, and in the rest case, the microinvasion can be observed which had a infiltrating scope between 0.78mm and 6.90mm while the middle infiltrating distance was 2.19mm. The 95% confidence interval of the well-differentiated, moderately differentiated, poorly differentiated liver cells were (0.25,2.84),(1.82,3.30) and (1.53,4.38)respectively. Besides, the confidence interval of the cholangiocellular carcinoma , the tumor diameter less than 4.5cm and the tumor diameter exceeded 4.5cm were (2.12,3.77),(1.55,3.09)and (1.91,3.54).Conclusion:1,From the radiotherapy of the target primary liver cancer, well-differentiated hepatocellular carcinoma can be extended outside the GTV based on the 2.84mm, middle infiltrating had an expansion of 3.30mm, and the poorly infiltrating with an expansion of 4.38mm. The diameter of the large tumor of hepatocellular which less than 4.5cm expanded 3.09mm on the base of GTV while the tumor with a cholangiocarcinoma at GTV extend outside the foundation on 3.77mm defined CTV, may include 95% of sub-clinical lesions. The large tumor with a diameter less than 4.5cm can expand 3.09cm outward which may include 95% of sub-clinical lesions.2,The difference of the micro-infiltration towards the different degree of differentiation has statistical significance, that is, the higher the degree of differentiation, micro-infiltration in the shorter distance, the lower the degree of the differentiation.