Assessment of hepatic function decline after stereotactic body radiation therapy for primary liver cancer.
OBJECTIVE
This study aims to determine how the albumin-bilirubin (ALBI) score compares with the Child-Pugh (CP) score for assessing liver function following stereotactic body radiation therapy (SBRT).


METHODS
In total, 60 patients, 40 with hepatocellular carcinoma (HCC) and 20 with cholangiocarcinoma (CCA), were treated with SBRT. Liver function panels were obtained before and at 1, 3, 6, and 12 months after SBRT. Laboratory values were censored after locoregional recurrence, further liver-directed therapies, or liver transplant.


RESULTS
A significant decline in hepatic function occurred after SBRT for HCC patients only (P = .001 by ALBI score; P < .0001 by CP score). By converting radiation doses to biologically equivalent doses by using a standard linear quadratic model using α/β of 10, the strongest dosimetric predictor of liver function decline for HCC was the volume of normal liver irradiated by a dose of 40 Gy when assessing liver function by the ALBI score (P = .07), and the volume of normal liver irradiated by a dose of 20 Gy by using the CP score (P= .0009). For CCA patients, the volume of normal liver irradiated by a dose of 40 Gy remained the strongest dosimetric predictor when using the ALBI score (P = .002), but no dosimetric predictor was significant using the CP score. Hepatic function decline correlated with worse overall survival for HCC (by ALBI, P = .0005; by CP, P < .0001) and for CCA (by ALBI, P = NS; by CP, P = .008).


CONCLUSIONS
ALBI score was similarly able to predict hepatic function decline compared with CP score, and both systems correlated with survival.
Radiation Oncology Department, Stanford University School of Medicine, Stanford, California.
Diego A S
DAS
Toesca
Radiation Oncology Department, Vanderbilt University School of Medicine, Nashville, Tennessee.
Evan C
EC
Osmundson
Radiation Oncology Department, Stanford University School of Medicine, Stanford, California.
Rie
R
von Eyben
Radiation Oncology Department, Stanford University School of Medicine, Stanford, California.
Jenny L
JL
Shaffer
Radiation Oncology Department, Stanford University School of Medicine, Stanford, California.
Albert C
AC
Koong
Radiation Oncology Department, Stanford University School of Medicine, Stanford, California. Electronic address: dtchang@stanford.edu.
Daniel T
DT
Chang
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy; D018281:Cholangiocarcinoma / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008099:Liver / Q000502:physiology* / Q000528:radiation effects; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology / Q000503:physiopathology; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D000075462:Serum Albumin, Human / Q000032:analysis*
D015415:Biomarkers; D001663:Bilirubin; D000075462:Serum Albumin, Human