title: Hepatic dysfunction after radiotherapy for primary gastric lymphoma.
abstract: Patients with primary gastric lymphoma (PGL) are often treated with three-dimensional conformal radiotherapy (3D-CRT) in three to four fields to reduce the dose to the left kidney. However, the liver dose is higher than conventional parallel-opposed fields. This study was designed to evaluate hepatic dysfunction after 3D-CRT in patients with PGL. The data of 20 PGL patients treated with 3D-CRT were analyzed. Of the 20 patients, 3 had mucosa-associated lymphoid tissue (MALT) lymphoma and 17 had diffuse large B-cell lymphoma (DLBCL). The median dose used to treat MALT lymphoma was 30 Gy and 40 Gy for DLBCL. Pretreatment and post-treatment transaminase and alkaline phosphatase (ALP) values were compared. Radiation-induced hepatic dysfunction (RIHD) was defined as a more than 2-fold increase in transaminase or ALP levels, exceeding the upper limit within 4 months of the completion of radiotherapy. Increased transaminase or ALP levels were observed in 19 patients (95%). RIHD was observed in 14 patients (70%). The transaminase and ALP values were significantly different between pretreatment and post-treatment. There were significant differences in liver volumes receiving ≥5, ≥10, ≥15 and ≥20 Gy (V5, V10, V15 and V20) and in the mean liver doses between patients with and without RIHD. For patients with V10 > 60%, V15 > 50% or V20 > 30% in particular, the incidence rates of RIHD were significantly high. After radiotherapy for PGL, hepatic dysfunction occurred at a high rate. Thus, radiotherapy treatment should be planned in order to reduce liver doses.
authors.affiliation: Department of Radiology, Gifu University Hospital, Yanagido 1-1, Gifu 501-1194, Japan. htanaka-gif@umin.ac.jp
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayashi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohtakara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hoshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology*; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000150:complications / Q000532:radiotherapy*; D016896:Treatment Outcome