title: Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance.
abstract: OBJECTIVE
  To identify risk factors relevant to radiation-induced liver disease (RILD) and to determine the hepatic tolerance to radiation.
  
  
  METHODS
  The data of 109 primary liver carcinomas (PLC) treated with hypofractionated three-dimensional conformal radiation therapy (3D-CRT) were analyzed. Seventeen patients were diagnosed with RILD and 13 of 17 died of it.
  
  
  RESULTS
  The risk factors for RILD were late T stage, large gross tumor volume, presence of portal vein thrombosis, association with Child-Pugh Grade B cirrhosis, and acute hepatic toxicity. Multivariate analyses demonstrated that the severity of hepatic cirrhosis was a unique independent predictor. For Child-Pugh Grade A patients, the hepatic radiation tolerance was as follows: (1) Mean dose to normal liver (MDTNL) of 23 Gy was tolerable. (2) For cumulative dose-volume histogram, the tolerable volume percentages would be less than: V5 of 86%, V10 of 68%, V15 of 59%, V20 of 49%, V25 of 35%, V30 of 28%, V35 of 25%, and V40 of 20%. (3) Tolerable MDTNL could be estimated by MDTNL (Gy) = -1.686 + 0.023 * normal liver volume (cm3).
  
  
  CONCLUSIONS
  The predominant risk factor for RILD was the severity of hepatic cirrhosis. The hepatic tolerance to radiation could be estimated by dosimetric parameters.
authors.affiliation: Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China.
authors.forename: Shi-Xiong
authors.initials: SX
authors.lastname: Liang
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhu
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Xu
authors.forename: Ji
authors.initials: J
authors.lastname: Zhu
authors.forename: Jian-Dong
authors.initials: JD
authors.lastname: Zhao
authors.forename: Hai-Jie
authors.initials: HJ
authors.lastname: Lu
authors.forename: Yun-Li
authors.initials: YL
authors.lastname: Yang
authors.forename: Long
authors.initials: L
authors.lastname: Chen
authors.forename: An-Yu
authors.initials: AY
authors.lastname: Wang
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Fu
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008099:Liver / Q000528:radiation effects*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016015:Logistic Models; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012372:ROC Curve; D011832:Radiation Injuries / Q000209:etiology*; D011836:Radiation Tolerance / Q000502:physiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012307:Risk Factors