title: Determination of the α/β ratio for the normal liver on the basis of radiation-induced hepatic toxicities in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  The purpose of this study was to determine the α/β ratio for normal liver with hepatitis by analyzing the toxicity data from patients with unresectable hepatocellular carcinoma treated with helical tomotherapy.
  
  
  METHODS
  Between March 2006 and February 2012, 98 patients were eligible for this study. 66 patients received 45-50 Gy in 4.5-5 Gy fractions (Group A) and 32 patients received 36-60 Gy in 2.5-3 Gy fractions (Group B). Radiation-induced hepatic toxicity was defined as an increase of at least 2 points in the Child-Pugh score within 4 months of completing helical tomotherapy. We attempted to find the statistically significant parameters in the 2 groups using α/β ratios of 2, 4, 6, 8, or 10, and compared the estimated probability curves of each significant parameter. We hypothesized that the α/β ratio associated with the best matches for the curves between the 2 groups would be equivalent to the α/β ratio for the normal liver.
  
  
  RESULTS
  When using an α/β ratio of 2 or 4, different parameters were found to be statistically significant in a multivariate analysis (Group A: VBED30 for α/β ratio=2 and VBED25 for α/β ratio=4, Group B: VBED25 for α/β ratio=2 and VBED20 for α/β ratio=4). When using an α/β ratio of 6, 8, or 10, VBED20 was found to be a statistically significant parameter in both groups. Comparison of the estimated probability curve of each significant parameter between the groups revealed that an α/β ratio of 8 resulted in the best matches.
  
  
  CONCLUSIONS
  We suggest that the α/β ratio of the normal liver with hepatitis is 8. We hope that previously reported parameters and their values can be effectively used in different fractionation schemes by calculating the biologically effective dose using an α/β ratio of 8.
authors.affiliation: Department of Radiation Oncology, Incheon St, Mary's Hospital, College of Medicine, the Catholic University of Korea, Incheon, Korea.
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Son
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Jang
authors.forename: Hyochun
authors.initials: H
authors.lastname: Lee
authors.forename: Byung Ock
authors.initials: BO
authors.lastname: Choi
authors.forename: Young Nam
authors.initials: YN
authors.lastname: Kang
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Chul Seung
authors.initials: CS
authors.lastname: Kay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006505:Hepatitis; D006801:Humans; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries; D011874:Radiometry; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012062:Relative Biological Effectiveness