Inclusion of biological factors in parallel-architecture normal-tissue complication probability model for radiation-induced liver disease.
OBJECTIVE
To include biologic factors in parallel-architecture normal-tissue complication probability (NTCP) model for radiation-induced liver disease (RILD) after three-dimensional conformal radiotherapy (3D-CRT) for gastric or hepatic cancer.


METHODS
A total of 151 patients (89 with hepatocellular carcinoma and 62 with gastric cancer) who received 3D-CRT to the liver were included (isocenter dose range 33.0 to 66.0 Gy; mean 48.0 Gy). RILD was defined as grade 3 or higher liver toxicity according to Common Toxicity Criteria Version 2.0 of the National Cancer Institute within 4 months after 3D-CRT. Possible correlations of patient-related or dosimetric factors with RILD were tested. Maximum-likelihood analysis estimated NTCP model parameters for group and subgroups. Goodness-of-fit analysis estimated deviance of NTCP model parameters between subgroups.


RESULTS
RILD developed in 25 patients. Hepatitis B virus carrier status (p < 0.001) was the only significant independent factor. The 4 parallel NTCP model parameters, mean functional reserve (V(50)), width of functional reserve distribution (sigma), dose damage to 50% of liver subunits (D(50)), and slope parameter for subunit dose-response (k), were respectively, 0.54, 0.14, 50 Gy, 0.18 (group); 0.53, 0.07, 50 Gy, 4.6 x 10(-7) (carriers); 0.59, 0.12, 25 Gy, 59.8 (noncarriers). In carrier-state subgroups, goodness-of-fit deviance with 1 subgroup's parameter set would have been worse in the other group. Across subgroups, patients with RILD all had liver fraction damage (f) greater than 0.4 compared with wider distribution for the whole group.


CONCLUSIONS
RILD is described with a parallel-architecture NTCP model for HBV carriers and noncarriers with a threshold effect greater than 0.4. The main difference is in slope parameter for subunit dose-response.
Cheng
Jason Chia-Hsien
JC
Department of Electrical Engineering, National Taiwan University, No. 1 Sec. 4 Roosevelt Road, Taipei 106, Taiwan. jason.cheng@ha.mc.ntu.edu.tw
Liu
Hua-Shan
HS
Wu
Jian-Kuen
JK
Chung
Hsiao-Wen
HW
Jan
Gwo-Jen
GJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy; D002353:Carrier State / Q000821:virology; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011336:Probability; D011832:Radiation Injuries / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000532:radiotherapy*