Korean J Intern Med.
2018 Nov;33(6):1093-1102. 10.3904/kjim.2016.412.
Clinical significance of radiation-induced liver disease after stereotactic body radiation therapy for hepatocellular carcinoma
- Affiliations
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- 1Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
- 2Department of Radiation Oncology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea.
- 3Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea.
- 4Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Korea.
- 5Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea. khskhs@schmc.ac.kr
- KMID: 2426393
- DOI: http://doi.org/10.3904/kjim.2016.412
Abstract
- BACKGROUND/AIMS
The aim of this study was to investigate parameters that predict radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to identify the clinical significance of RILD.
METHODS
We retrospectively reviewed the medical records of 117 HCC patients who were treated by SBRT from March 2011 to February 2015. RILD was defined as elevated liver transaminases more than five times the upper normal limit or a worsening of Child-Pugh (CP) score by 2 within 3 months after SBRT. All patients were assessed at 1 month and every 3 months after SBRT.
RESULTS
Median follow-up was 22.5 months (range, 3 to 56) after SBRT. RILD was developed in 29 of the 117 patients (24.7%). On univariate analysis, significant predictive factors of RILD were pretreatment CP score (p < 0.001) and normal liver volume (p = 0.002). Multivariate analysis showed that CP score was a significant predictor of RILD (p < 0.001). The incidence of RILD increased above a CP score of 6 remarkably. The rate of recovery from RILD decreased significantly above a CP score of 8. Survival analysis showed that CP score was an independent prognostic factor of overall survival (p = 0.001).
CONCLUSIONS
CP score is a significant factor to predict RILD in patients with chronic liver disease. RILD can be tolerated by patients with a CP score ≤ 7. However, careful monitoring of liver function is needed for patients with a CP score 7 after SBRT.
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