Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma.
BACKGROUND
We attempted to analyze the effects of an increase in the Child-Pugh (CP) score on the overall survival of patients with unresectable hepatocellular carcinoma (HCC) after radiotherapy (RT).


METHODS
From March 2006 to February 2012, 103 patients received RT using the TomoTherapy Hi-Art at Incheon St. Mary's Hospital and Seoul St. Mary's Hospital. The dose per fraction was 1.8-5 Gy, and the total dose was 40-60 Gy (median, 50 Gy). We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.


RESULTS
The median follow-up duration was 11.6 months (range, 3.5-85.3 months). The median survival time was 11.6 months. In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively). In a comparison of cases with and without an increase in the CP score, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.


CONCLUSIONS
An increase of at least 2 points in the CP score within 3 months of RT completion is an important on-treatment factor that affects overall survival. To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.
Seok Hyun
SH
Son
Hong Seok
HS
Jang
In-Young
IY
Jo
Byung Ock
BO
Choi
Jeong Won
JW
Jang
Seung Kew
SK
Yoon
Department of Radiation Oncology, Incheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. k41645@chol.com.
Chul Seung
CS
Kay
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult