Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance.
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.
Liang
Shi-Xiong
SX
Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China.
Zhu
Xiao-Dong
XD
Xu
Zhi-Yong
ZY
Zhu
Ji
J
Zhao
Jian-Dong
JD
Lu
Hai-Jie
HJ
Yang
Yun-Li
YL
Chen
Long
L
Wang
An-Yu
AY
Fu
Xiao-Long
XL
Jiang
Guo-Liang
GL
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