title: Adverse hepatic events caused by radiotherapy for advanced hepatocellular carcinoma.
abstract: BACKGROUND
  Radiotherapy is often used to treat patients with unresectable advanced hepatocellular carcinoma (HCC). The present study examines the nature and frequency of adverse events with respect to liver function in such patients after radiotherapy.
  
  
  METHODS
  Forty-six patients with HCC who underwent radiotherapy were retrospectively examined. Radiotherapy was applied using coplanar 2-3-beam arrangements to a target dose of 50 Gy/5 weeks. The adverse hepatic events were evaluated according to the National Cancer Institute Common Toxicity Criteria and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme during the acute phase and the late phase by following the patients for up to 1 year. The influence on survival by adverse hepatic events and other factors was analyzed.
  
  
  RESULTS
  The full irradiation dose of 50 Gy was given to 40 patients (87.0%). Grade 3 or 4 toxicity was observed in 18 (39.1%) within 3 months after radiotherapy and in 11 (33.3%) of 33 thereafter, respectively. The most frequent and serious adverse events were hyperbilirubinemia, hypoalbuminemia, and ascites. The independent adverse prognostic factors for survival were portal vein tumor thrombus (P = 0.0012), tumor response (P = 0.011), acute adverse hepatic event (P = 0.012), and late adverse hepatic event (P = 0.015).
  
  
  CONCLUSIONS
  Hypoalbuminemia, hyperbilirubinemia, and ascites were important hepatic adverse events that developed after applying radiotherapy to treat advanced HCC. These adverse events seriously affected survival.
authors.affiliation: Division of Hepatobiliary and Pancreatic Medical Oncology, National Cancer Center Hospital East, Chiba, Japan. jfuruse@east.ncc.go.jp
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagase
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Kawashima
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogino
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D034141:Hypoalbuminemia / Q000209:etiology; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000453:epidemiology*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome