title: Influence of liver toxicities on prognosis after stereotactic body radiation therapy for hepatocellular carcinoma.
abstract: OBJECTIVE
  To better define clinically relevant non-classic radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with small hepatocellular carcinoma (HCC).
  
  
  METHODS
  We retrospectively evaluated the influence of acute liver toxicities on fatal hepatic failure in HCC patients treated with SBRT. Between April 2006 and February 2012, 194 HCC were treated with SBRT. Among them, patients followed up for more than 6 months were eligible. Laboratory results and Child-Pugh (CP) scores were obtained before treatment and at monthly follow-up visits. Toxicities were evaluated by the Common Terminology Criteria for Adverse Events version 4.0. Possible definitions of RILD were evaluated with respect to fatal hepatic failure within 12 months.
  
  
  RESULTS
  One hundred and eighty HCC were evaluated with a median follow-up of 28.2 months. Fatal hepatic failure within 12 months occurred in eight patients (4%). On univariate analysis, grade 3 or more elevated transaminases, CP score of 8 or more, and/or grade 3 or more decreased platelet count significantly predicted fatal hepatic failure within 12 months. Combinations of these factors (i.e. having at least one criterion) also predicted fatal hepatic failure within 12 months (16% with criteria vs 1% without criteria). Two-year overall survival rates for patients with and without RILD was 64.9% and 83.8% (P < 0.001), respectively.
  
  
  CONCLUSIONS
  We identified three criteria that affected overall survival in HCC patients treated with SBRT. Further prospective studies are warranted to validate the safety and effect of SBRT for HCC.
authors: Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan; Department of Radiation Oncology, Tokai University, Isehara, Japan.
authors: Naoko
authors: N
authors: Sanuki
authors: Atsuya
authors: A
authors: Takeda
authors: Yohei
authors: Y
authors: Oku
authors: Takahisa
authors: T
authors: Eriguchi
authors: Shuichi
authors: S
authors: Nishimura
authors: Yosuke
authors: Y
authors: Aoki
authors: Etsuo
authors: E
authors: Kunieda
keywords: hepatocellular carcinoma; liver cirrhosis; radiation-induced liver disease; stereotactic ablative body radiotherapy