Korean J Hepatol.  2006 Sep;12(3):420-428.

Reappraisal of Risk Factors Predicting Liver Complications from Radiotherapy for Hepatocellular Carcinoma

• Lee IJ
• Seong J
• Shim SJ
• Han KH
• Chon CY

Abstract

BACKGROUND/AIMS: Determination of the optimal radiotherapeutic parameters for radiotherapy of hepatocellular carcinoma (HCC) is still under investigation. The purpose of this study is to identify the risk factors associated with radiation-related morbidity. METHODS: We evaluated one hundred fifty-eight patients, who were given radiotherapy for HCC between January 1992 and March 2000. Radiation-induced liver disease (RILD) was defined as the development of nonmalignant ascites without disease progression and an anicteric elevation of the alkaline phosphatase level by at least twofold. Gastrointestinal toxicity was assessed by using the RTOG-EORTC scale. RESULTS: Six patients (3.8%) displayed RILD. In these patients, three patients had not responded to other previous treatments. Two patients with portal vein thrombosis or huge sized mass, above 10 cm, showed liver toxicity and two other patients presented with Child-Pugh class B liver cirrhosis. Eight patients (5%) had gastro-duodenal ulcers. In one of these 8 patients, the left lobe close to the stomach was involved and two patients had been treated for gastro-duodenal ulcer. In two more patients, the radiation field, with using anterior/posterior radiation ports, covered a significant volume of the gastrointestinal tract. One of eight patients had been irradiated with a large fraction size (250 cGy). CONCLUSIONS: The efforts should be made to reduce the radiation-related complications for hepatocellular carcinoma by considering the volume and the function of remaining liver, the location of tumor, the tumor size and the severity of liver cirrhosis.

Keyword

Hepatocellular carcinoma; Radiotherapy; Radiation injuries; Radiation-induced liver disease; Peptic ulcer

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/complications/*radiotherapy
Female
Humans
Liver Cirrhosis/diagnosis/*etiology
Liver Neoplasms/complications/*radiotherapy
Male
Middle Aged
Peptic Ulcer/etiology
Radiotherapy Dosage
Risk Factors