title: Dose-volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy.
abstract: OBJECTIVE
  To identify the dose-volumetric parameters associated with the risk of radiation-induced hepatic toxicity (RIHT) in hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy.
  
  
  METHODS
  A total of 105 hepatocellular carcinoma patients underwent three-dimensional conformal radiotherapy (total dose range, 44-58.5 Gy; median, 54). RIHT was scored within 4 months of completing three-dimensional conformal radiotherapy. The dose-volume parameters analyzed were the gross tumor volume; normal liver volume; total liver volume; radiation dose; mean dose to the normal liver; percentage of the normal liver volume receiving > or =20, > or =25, > or =30, > or =35, and > or =40 Gy; percentage of the total liver volume receiving > or =20, > or =25, > or =30, > or =35, and > or =40 Gy; and the normal tissue complication probability.
  
  
  RESULTS
  Of the 105 patients, Grade 1 RIHT was observed in 21 (20.0%), Grade 2 in 7 (6.7%), Grade 3 in 5 (4.8%), and Grade 4 in 1 (1.0%) patient. No fatal Grade 5 RIHT developed. On multivariate analysis for predicting Grade 2 or worse RIHT, the total liver volume receiving > or =30 Gy was the only significant parameter (p < 0.001). Grade 2 or worse RIHT was observed in only 2 (2.4%) of 85 patients with a total liver volume receiving 30 Gy of < or =60% and in 11 (55.0%) of 20 patients with >60% (p < 0.001).
  
  
  CONCLUSIONS
  The total liver volume receiving > or =30 Gy appears to be a useful dose-volumetric parameter for predicting the risk of RIHT. This volume should be limited to < or =60% whenever possible to minimize the risk of Grade 2 or worse RIHT.
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Joon-Il
authors.initials: JI
authors.lastname: Choi
authors.forename: Hyun Beom
authors.initials: HB
authors.lastname: Kim
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Sang Jae
authors.initials: SJ
authors.lastname: Park
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Hong
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000473:pathology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies