title: Radiation-induced liver disease after stereotactic body radiotherapy for small hepatocellular carcinoma: clinical and dose-volumetric parameters.
abstract: BACKGROUND
  To investigate the clinical and dose-volumetric parameters that predict the risk of radiation-induced liver disease (RILD) for patients with small, unresectable hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT).
  
  
  METHODS
  Between March 2007 and December 2009, 92 patients with HCC treated with SBRT were reviewed for RILD within 3 months of completing treatment. RILD was evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. A dose of 10-20 Gy (median, 15 Gy) per fraction was given over 3-4 consecutive days for a total dose of 30-60 Gy (median, 45 Gy). The following clinical and dose-volumetric parameters were examined: age, gender, Child-Pugh class, presence of hepatitis B virus, gross tumor volume, normal liver volume, radiation dose, fraction size, mean dose to the normal liver, and normal liver volumes receiving from < 5 Gy to < 60 Gy (in increments of 5 Gy).
  
  
  RESULTS
  Seventeen (18.5%) of the 92 patients developed grade 2 or worse RILD after SBRT (49 patients in grade 1, 11 in grade 2, and 6 in ≥ grade 3). On univariate analysis, Child-Pugh class was identified as a significant clinical parameter, while normal liver volume and normal liver volumes receiving from < 15 Gy to < 60 Gy were the significant dose-volumetric parameters. Upon multivariate analysis, only Child-Pugh class was a significant parameter for predicting grade 2 or worse RILD.
  
  
  CONCLUSIONS
  The Child-Pugh B cirrhosis was found to have a significantly greater susceptibility to the development of grade 2 or worse RILD after SBRT in patients with small, unresectable HCC. Additional efforts aimed at testing other models to predict the risk of RILD in a large series of HCC patients treated with SBRT are needed.
authors.forename: Jinhong
authors.initials: J
authors.lastname: Jung
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea. drsmyoon@amc.seoul.kr.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Yoon
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Byungchul
authors.initials: B
authors.lastname: Cho
authors.forename: Jin-hong
authors.initials: JH
authors.lastname: Park
authors.forename: Su Ssan
authors.initials: SS
authors.lastname: Kim
authors.forename: Si Yeol
authors.initials: SY
authors.lastname: Song
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Ahn
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choi
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000209:etiology*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology*; D011874:Radiometry; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome