title: Clinical parameters for predicting radiation-induced liver disease after intrahepatic reirradiation for hepatocellular carcinoma.
abstract: BACKGROUND
  Few data are available on the tolerance of reirradiation in patients with hepatocellular carcinoma (HCC). This study determined the clinical parameters contributing to the development of radiation-induced liver disease (RILD).
  
  
  METHODS
  We included 36 patients with HCC who received 2 courses of radiotherapy (RT) to the liver. Using α/β = 15 for tumor and α/β =8 for normal liver tissue for biologically equivalent doses in 2 Gy fractions, mean cumulative to the hepatic tumor and normal liver were 87.7 Gy15 and 31.1 Gy8, respectively. Hepatic toxicities were classified according to the Common Terminology Criteria for Adverse Events, Version 4.0. Clinical data, including liver function test results, radiological study findings, and RT parameters before and after both courses of RT were retrieved for analysis. Using multivariate analysis, logistic regression was used to identify the predictors of RILD, and Cox regression was performed to explore the prognostic factors for overall survival (OS).
  
  
  RESULTS
  Thirteen patients (36 %) developed RILD after reirradiation. Nine of them died because of progressive liver failure without evidence of tumor progression and were categorized to have lethal RILD. A pretreatment Child-Turcotte-Pugh (CTP) score ≥6 was the only predictor of RILD [odds ratio (OR): 15.83, p = 0.001] and lethal RILD [OR: 72.56, p = 0.005]. In addition, a CTP score ≥6 and the presence of portal vein tumor thrombosis before reirradiation were 2 prognostic factors for OS.
  
  
  CONCLUSIONS
  Despite a limited sample size, residual liver function using a preirradiation CTP score ≥6 is a clinical parameter associated with an increased risk of RILD in patients requiring hepatic reirradiation.
authors.affiliation: Department of Radiation Oncology, Taipei Medical University Hospital, 252, Wu Hsing St., Taipei, 110, Taiwan.|Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yaoru
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.|Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Saint Mary's Hospital, Luodong, Taiwan.
authors.forename: Ching-Chao
authors.initials: CC
authors.lastname: Fan
authors.affiliation: Department of Radiation Oncology, Taipei Medical University Hospital, 252, Wu Hsing St., Taipei, 110, Taiwan.|Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Lai-Lei
authors.initials: LL
authors.lastname: Ting
authors.affiliation: Department of Radiation Oncology, Taipei Medical University Hospital, 252, Wu Hsing St., Taipei, 110, Taiwan.|Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chia-Chun
authors.initials: CC
authors.lastname: Kuo
authors.affiliation: Department of Radiation Oncology, Taipei Medical University Hospital, 252, Wu Hsing St., Taipei, 110, Taiwan. solomanc@tmu.edu.tw.|Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. solomanc@tmu.edu.tw.
authors.forename: Jeng-Fong
authors.initials: JF
authors.lastname: Chiou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology*; D011874:Radiometry; D000069475:Re-Irradiation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hepatocellular carcinoma; Irradiation; Prognostic factor; Radiation-induced liver disease