title: Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT).
  
  
  METHODS
  A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30-50 Gy (median 37.5 Gy) in 2-5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the ≥ grade 2 GD toxicity were investigated.
  
  
  RESULTS
  Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V25 for stomach and V35 for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for ≥ grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V25 ≤ 6.3 % and 57.1 % for V25 > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V35 ≤ 5.4 % and 45.9 % for V35 > 5.4 %. By multivariate analysis including the clinical factors, V25 for stomach and V35 for duodenum were the significant factors.
  
  
  CONCLUSIONS
  EGD revealed that GD toxicity is common following RT for HCC. V25 for the stomach and V35 for the duodenum were the significant factors to predict ≥ grade 2 GD toxicity.
authors.affiliation: Department of Health Sciences and Technology, School of Medicine & Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Yoon
authors.forename: D
authors.initials: D
authors.lastname: Oh
authors.forename: H C
authors.initials: HC
authors.lastname: Park
authors.forename: S W
authors.initials: SW
authors.lastname: Kang
authors.forename: Y
authors.initials: Y
authors.lastname: Han
authors.forename: D H
authors.initials: DH
authors.lastname: Lim
authors.forename: S W
authors.initials: SW
authors.lastname: Paik
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology; D004382:Duodenitis / Q000175:diagnosis / Q000209:etiology; D004386:Duodenum / Q000528:radiation effects*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography; D005756:Gastritis / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012307:Risk Factors; D013270:Stomach / Q000528:radiation effects*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology; D047368:Tumor Burden