title: Predictive factors for Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy: dose-volume histogram analysis.
abstract: OBJECTIVE
  We designed the study to identify the clinical and dose-volumetric parameters associated with the risk of Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy.
  
  
  METHODS
  All 161 hepatocellular carcinoma patients in the study underwent 4D-computed tomography simulation, and a dose-volume histogram was generated after radiotherapy planning. Patients who had an elevated Child-Pugh (e-CP) score of 2 or more without progressive disease within 3 months were defined as e-CP positive.
  
  
  RESULTS
  Twenty-six of 142 patients without progressive disease were e-CP positive. Pretreatment Child-Pugh class, further treatment within 30 days of radiotherapy, lymph node metastasis, mean liver dose, V(20 Gy), V(25 Gy), and V(30 Gy) were significantly correlated with e-CP positivity. The e-CP developed in 13 of 106 patients (12.3%) with V(30 Gy) of ≤28.1% and in 13 of 36 patients (36.1%) with V(30 Gy) >28.1% (P = 0.001).
  
  
  CONCLUSIONS
  Our data demonstrate that mean liver dose, V(10 Gy), V(20 Gy), V(25 Gy), and V(30 Gy) are independent dose-volumetric predictors for e-CP positivity in hepatocellular carcinoma patients treated with conformal radiation therapy. V(30 Gy) should be limited to less than 28.1% to minimize the risk of e-CP.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong Il
authors.initials: JI
authors.lastname: Yu
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Park
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Lim
authors.forename: Woo Yoon
authors.initials: WY
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000532:radiotherapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index