| Primary hepatic carcinoma are from those cells, including liver cells or intrahepatic bile duct cancer cells, The cancer mortality rate is in the third place after gastric cancer, esophageal cancer in depictive system. With nearly 10 years the popularity of diagnostic imaging, radiotherapy equipment, the progress of awareness of comprehensive cancer treatment, in particular, the combination of intervention and radiotherapy, and HCC(hepatic cell carcinoma) was confirmed radiation-sensitive tumor by radiation biology, liver cancer radiotherapy was widespread paid attention. Since a large area of radiation therapy in early trials, including half of liver and even the whole liver radiotherapy, radiotherapy is poor due to severe liver injury radioactivity (radiation-induced liver disease, RILD ), so that the radiation dose to the liver is not high, amounting to less than a radical purpose. With the development of imaging, including the virtual reconstruction of the three-dimensional structure of surrounding normal structures and the tumor, the invention of radiotherapy planning computer system (TPS), the help in the design of radiotherapy TPS program, including the radiation field settings, dose calculation, plan optimization, in particular, the average dose and the distribution in the liver can be obtained, three-dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), Gamma Knife (Gamma-knife), kinds of radiation technology are increasingly used in the treatment of liver tumors. In addition to difference of its basic principles and the device itself and dose fractionation in different ways, the biggest difference is that the planning system. The Planning system can not represent specific data of three-dimensional organ-specific spatial location and not take into account sub-image, but its greatest success is to create a quantitative analysis and volume and clinical studies related practical applications. Because the 3D dose data have clinical relevance, even in the present can be applied under conditions of limited data, treatment planning system prompts the physician treatment plan to set the security mode. The patient can be given individual treatment by Doctors according to the specific circumstances, in particular liver cancer patients.As the replacement of radiotherapy equipment from the era of two-dimensional to three-dimensional development of the times, dose fractionation from the conventional to large doses of choice, appliance from using palliative care without 3D images which not accustomed nowadays to the reference on 3D dose distribution, there is no complete reports of the dose distribution of three different treatments. Historically, the choice of radiation treatment field and the radiation dose rely on clinical experience when physicians rely on clinical intuition to select the exposure mode and exposure dose of radiation field, so use of 3D dose data to select a different medical treatment is a new consideration of radiotherapy. "Emami paper" in 1991 and QUANTEC (quantec quantitative analysis of normal tissue effects in the clinic) in 2010 give the guidance in a dose parameters, but did not analyze the domestic of three different treatment. Therefore, by collecting and comparing case data would be an effective way to solve this problem.Objective: This experiment is on 20 cases of primary liver cancer patients who applied three-dimensional conformal (3-Dimensional Conformal Radiotherapy, 3-DRT), IMRT (Intensity Modulated Radiotherapy, IMRT) and Gamma Knife (Gamma -Knife) given the same prescription dose in radiation for treatment of primary liver to guide the choice of liver cancer radiation treatment planning, to improve the target dose of radiation, to reduce or avoid the occurrence of liver disease and better protect endangered organs.Method:1 20 cases were diagnosed as hepatocellular carcinoma confirmed by pathology in August 2009 to December 2010, 16 cases of males and 4 females, age 40-60 years, mean age 52 years. In accordance with the Couinaud liver eight function zoning , 12 cases of right lobe of liver, 7 cases of liver left lobe,1 in and between right and left lobe of liver lobe. According to gross pathological classification of PLC, block in 5 cases, nodular in 13 cases, 2 cases of small hepatocellular carcinoma. Hepatitis background of 11 cases and no hepatitis background in 4 cases, 5 cases of unknown .19 cases of child grade A, B grade 1 case, 8 cases after TACE , 12 patients without post-TACE. 6 cases in well-differentiated Pathological type of hepatocellular carcinoma, 13 cases moderately differentiated, poorly differentiated in 1 case. Groups Divided into A group: tumor size >5CM, 10 cases, B group: tumor size< 5CM, 10 cases.2 The images of 20 patients with HCC positioning under CT scan machine transfer to a three-dimensional conformal, IMRT and Gamma Knife planning system and was outlined the tumor target volume and adjacent organs at risk, respectively. Each patient do 3DRT, IMRT, GAMA-KNIFE three plans, A group was treated with TD = 3600CGy, 300×12F, B group was treated with TD =5000CGy, 500CGy×10F. index CI(CI = target volume / surface of the reference dose line wrapping the target volume, value between 0-1, equal to 1 for the best) and The maximum dose Dmax (Gy)of PTV, the average dose Dmean (Gy)of PTV, whole liver mean dose, V5, V30, maximum dose Dmax (Gy) of organs at risk including right kidney, stomach, were compared .Results: Tumors: A, B groups were given the same within the prescribed dose when the 95% PTV coverage, PTV in 3DMRT, IMRT, Gamma-Knife conformal radiotherapy oncology degrees (CI) were significantly different, A three-dimensional conformal group CI=81.7%, intensity modulated CI=87.34%, Gamma CI=69.34%, B group of three-dimensional conformal CI=64.97%, intensity modulated CI=71.86%, Gamma CI=75.27%, V5 of A group in the gamma Knife was significantly greater than other technologies, three-dimensional conformal and intensity modulated have no difference P = 0.87, B group: knife, three-dimensional conformal and intensity modulated were undifferentiated, P=0.864. V30 data is not statistically significant difference (p>0.05), tumor maximum (TUmax )A Group: IMRT, 3DRT, GAMA-KNIFE were 4001CGy, 4254.2CGy, 7999.9CGy, B group:5435.5CGy, 5696.4CGy, 9090.9CGy. Whole liver mean dose A group: IMRT, 3DRT, GAMA-KNIFE are 2889CGy, 2836CGy, 3552CGy, the B group there are significant differences (P=0.00). Organs at risk: the IMRT can better protect the stomach of normal tissue, gamma dose was the greatest contribution to the stomach, three techniques of large doses of liver cancer in the right kidney was no difference in contribution (P <0.05), gamma knife in the small dose contribution of hepatocellular carcinoma with 3-DRT and IMRT significantly different, the greatest contribution to the dose distribution.Conclusion: The analysis showed homogeneity of variance of three treatment modalities can provide satisfactory coverage of target dose, intensity modulated (IMRT) in the large degree of liver cancer conformal radiotherapy is superior to other technologies. Gamma knife in small hepatocellular carcinoma conformal better than other techniques, gamma knife inside the tumor to provide higher doses to achieve the purpose of cure. IMRT will better protect the normal liver tissue, the maximum gamma dose on the liver, liver cancer three techniques for large contributions in the right kidney was no difference in dose, gamma dose contribution in small hepatocellular carcinoma with IMRT and Three-dimensional conformal significant differences, the largest contribution to the dose distribution...
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