fig1

Figure 1. Treatment plan of a patient with an 18-cm hepatocellular carcinoma with extension into the hepatic veins, inferior vena cava and right atrium. Deep inspiration breath-hold was used for motion management. Representative arterial phase images from the simulation computed tomography (CT) are shown in the first column at the level of mid-liver (first row) and at the level of the right atrium (second row), with corresponding dose color wash distributions in all planes immediately to the left. Lowest dose displayed in deep blue is 45 Gy (in 25 fractions) and central hotspot is 75 Gy. Intracardiac extension was treated to 50 Gy. A representative cone beam CT image is shown in the third row