Dosimetric predictor identification for radiation-induced liver disease after hypofractionated conformal radiotherapy for primary liver carcinoma patients with Child-Pugh Grade A cirrhosis.
OBJECTIVE
Radiation-induced liver disease (RILD) is the most severe complication in liver cancer treatment. The aim of this study was to identify dosimetric predictors for RILD in primary liver carcinoma (PLC) patients with Child-Pugh Grade A cirrhosis after hypofractionated conformal radiotherapy (CRT).


METHODS
A total of 114 eligible patients (mean age 45 years old) were enrolled and treated. The mean gross tumor volume (GTV) was (378.3±308.1) cm(3). A median dose of 53 Gy was delivered to the PLC by hypofractionated CRT (three fractions/week) with a median fraction size of 4.6 Gy (range: 4-6 Gy).


RESULTS
Patients were followed up for 1-79 months (median 19 months) after the completion of irradiation. RILD was diagnosed in nine (7.9%) patients. Univariate analyses revealed that GTV and the percentage of normal liver volume receiving more than 5-40 Gy irradiations (V(5-40)) were related to the risk of developing RILD. Multivariate analyses demonstrated that only GTV and V(20) were independent predictors. Using V(20) as the predictor for RILD, the accuracy, sensitivity, and specificity was 76.3%, 88.9%, and 75.2%, respectively.


CONCLUSIONS
Our data suggest that V(20) is the unique significant dosimetric predictor for RILD risks in PLC patients with Child-Pugh Grade A cirrhosis after hypofractionated CRT.
Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning, China. shixliang@vip.sina.com
Shi-Xiong
SX
Liang
Xiao-Bo
XB
Huang
Xiao-Dong
XD
Zhu
Wei-Dong
WD
Zhang
Lin
L
Cai
Hua-Zhong
HZ
Huang
Ye-Fei
YF
Li
Long
L
Chen
Meng-Zhong
MZ
Liu
D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008107:Liver Diseases / Q000209:etiology*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*