title: Low Hepatic Toxicity in Primary and Metastatic Liver Cancers after Stereotactic Ablative Radiotherapy Using 3 Fractions.
abstract: This study evaluated the incidence of hepatic toxicity after stereotactic ablative radiotherapy (SABR) using 3 fractions to the liver, and identified the predictors for hepatic toxicity. We retrospectively reviewed 78 patients with primary and metastatic liver cancers, who underwent SABR using 3 fractions between 2003 and 2011. To examine the incidence of hepatic toxicity, we defined newly developed hepatic toxicity≥grade 2 according to the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 within 3 months after the end of SABR as a significant adverse event. To identify the predictors for hepatic toxicity, we analyzed several clinical and dosimetric parameters (rV5Gy-rV35Gy: normal liver volume receiving <X Gy, reverse VXGy). Hepatic toxicity≥grade 2 occurred in 10 patients (13%): grade 2 in 9 patients and grade 3 in 1 patient. On univariate analysis, baseline Child-Pugh (CP) score (5 vs. 6-8), normal liver volume, and planning target volume were the significant clinical predictors. All dosimetric parameters were significant: rV20Gy was the most significant predictor. On multivariate analysis, baseline CP score (hazard ratio, 0.026; P=0.001) was the only significant predictor. In conclusion, SABR using 3 fractions in primary and metastatic liver cancers produces low hepatic toxicity, especially in patients with a baseline CP score of 5. However, further studies are needed to minimize hepatic toxicity in patients with baseline CP scores≥6.
authors.affiliation: Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Sun Hyun
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Mi-Sook
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Won Il
authors.initials: WI
authors.lastname: Jang
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Chul Koo
authors.initials: CK
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Yoo
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Kum Bae
authors.initials: KB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Chul Ju
authors.initials: CJ
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Su Cheol
authors.initials: SC
authors.lastname: Park
authors.affiliation: CyberKnife Center, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Dong Han
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006505:Hepatitis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome
keywords: Child-Pugh Score; Hepatic Toxicity; Liver Neoplasms; Predictor; Stereotactic Body Radiotherapy