title: Radiation-induced Liver Injury after 3D-conformal Radiotherapy for Hepatocellular Carcinoma: Quantitative Assessment Using Gd-EOB-DTPA-enhanced MRI.
abstract: Focal liver reaction (FLR) appears in the hepatobiliary-phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) following radiotherapy (RT). We investigated the threshold dose (TD) for FLR development in 13 patients with hepatocellular carcinoma (HCC) who underwent three-dimensional conformal radiotherapy (3D-CRT) with 45 Gy in 15 fractions. FLR volumes (FLRVs) were calculated based on planning CT images by referring to fused hepatobiliary- phase images. We also calculated the TD and the irradiated volumes (IVs) of the liver parenchyma at a given dose of every 5 Gy (IVdose) based on a dose-volume histogram (DVH). The median TD was 35.2 Gy. The median IV20, IV25, IV30, IV35, IV40, and IV45 values were 371.1, 274.8, 233.4, 188.6, 145.8, and 31.0 ml, respectively. The median FLRV was 144.9 ml. There was a significant difference between the FLRV and IV20, IV25, and IV45 (p<0.05), but no significant differences between the FLRV and IV30, IV35, or IV40. These results suggest that the threshold dose of the FLR is approx. 35 Gy in HCC patients who undergo 3D-CRT in 15 fractions. The percentage of the whole liver volume receiving a dose of more than 30-40 Gy (V30-40) is a potential candidate optimal DVH parameter for this fractionation schedule.
authors.affiliation: Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fukugawa
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Namimoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Toya
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Saito
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yuki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Matsuyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Natsuo
authors.initials: N
authors.lastname: Oya
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy*; D003287:Contrast Media / Q000008:administration & dosage*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Gd-EOB-DTPA; hepatocellular carcinoma; magnetic resonance imaging; radiation-induced liver disease; radiotherapy