title: Dose volume histogram analysis of focal liver reaction in follow-up multiphasic CT following stereotactic body radiotherapy for small hepatocellular carcinoma.
abstract: OBJECTIVE
  To investigate threshold dose (TD) of focal liver reaction (FLR) following stereotactic body radiotherapy (SBRT) for patients with hepatocellular carcinoma (HCC) and liver cirrhosis.
  
  
  METHODS
  In consecutive 50 patients receiving SBRT for small HCC, 38 patients receiving SBRT and follow up >6 months, FLR on follow-up CT had been previously studied. Patients with good concordance between FLR and highly irradiated area were eligible. Dose volume histogram (DVH) was used to identify TDs for FLR. Clinical factors were analyzed for correlation with TDs.
  
  
  RESULTS
  Of 24 eligible patients, 23 had Child-Pugh score A and 1 scored B. Presence of FLR peaked at a median of 6 (range; 3-12) months. The median and 95% confidential intervals of TDs of pre-contrast and portal-venous phase CT were 32.4 Gy (30.3-35.4) and 34.4 Gy (31.9-36.0), respectively. Each median coefficient representing the concordance was 74.9% (range; 55.8-98.0%) and 80.5% (range; 70.8-92.4%), respectively. No clinical factors significantly correlated with the TDs.
  
  
  CONCLUSIONS
  We proposed 30 Gy/5 fractions as TD of FLRs following SBRT for patients with HCC and liver cirrhosis. This TD will enable us to predict injured liver volume and to avoid complication beforehand from toxicity. Further pathological and clinical studies, in addition to more practical and precise data of DVH, are needed to clarify the significance of FLRs.
authors.affiliation: Department of Radiology, Ofuna Chuo Hospital, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Takeda
authors.forename: Yohei
authors.initials: Y
authors.lastname: Oku
authors.forename: Naoko
authors.initials: N
authors.lastname: Sanuki
authors.forename: Etsuo
authors.initials: E
authors.lastname: Kunieda
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Koike
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Aoki
authors.forename: Toshio
authors.initials: T
authors.lastname: Ohashi
authors.forename: Shogo
authors.initials: S
authors.lastname: Iwabuchi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takatsuka
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takeda
authors.forename: Akitomo
authors.initials: A
authors.lastname: Sugawara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*