J Korean Med Sci.  2015 Aug;30(8):1055-1061. 10.3346/jkms.2015.30.8.1055.

Low Hepatic Toxicity in Primary and Metastatic Liver Cancers after Stereotactic Ablative Radiotherapy Using 3 Fractions

• Bae SH
• Kim MS
• Jang WI
• Cho CK
• Yoo HJ
• Kim KB
• Han CJ
• Park SC
• Lee DH

• KMID: 2164499
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1055

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> or =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 (rV(5Gy)-rV(35Gy): normal liver volume receiving or =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: rV(20Gy) 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> or =6.

Keyword

Child-Pugh Score; Liver Neoplasms; Hepatic Toxicity; Predictor; Stereotactic Body Radiotherapy

MeSH Terms

Aged
*Dose Fractionation
Female
Hepatitis/*etiology/pathology/prevention & control
Humans
Liver Neoplasms/complications/pathology/*surgery
Male
Middle Aged
Neoplasm Metastasis
Radiation Injuries/*etiology/pathology/prevention & control
Radiosurgery/*adverse effects/*methods
Radiotherapy Dosage
Treatment Outcome

Figure

• 

  Fig. 1 Dose-volume histograms (DVHs) of the normal liver (total liver volume minus planning target volume) from all patients. Grey color indicates patients with a CP score of 5; blue color with a CP score of 6; green color with a CP score of 7; red color with a CP score of 8. Solid lines represent patients without hepatic toxicity; dotted line with hepatic toxicity ≥grade 2.

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