Dose–volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy

Kim, Tae Hyun; Kim, Dae Yong; Park, Joong-Won; Kim, Seong Hoon; Choi, Woo Hee; Kim, Hyun Beom; Lee, Woojin; Park, Sang Jae; Hong, Eun Kyung; Kim, In Soo

doi:10.1016/j.ijrobp.2006.08.015

Cited by 138 publications

(131 citation statements)

References 22 publications

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“…This serious condition is receiving attention now that whole organ irradiation is infrequently administered [7,8,[11][12][13]. Most symptoms of nonclassical RILD resemble those of hepatic failure, including markedly elevated levels of serum transaminases and worsening of the Child-Pugh score (e.g., jaundice, ascites).…”

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confidence: 99%

“…3. (2) Decline in liver function (worsening of Child-Pugh class ≥ 2) in the absence of classical RILD [7,11]. Sanuki et al define three clinically relevant events that affect overall survival of patients with hepatocellular carcinoma (HCC) if they occur within 12 months after administration of SBRT as follows: (1) Elevated liver transaminase levels (CTCAE Gr.…”

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confidence: 99%

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Pathology and images of radiation-induced hepatitis: a review article

et al. 2018

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Recent advances in highly conformal radiotherapies greatly extend the indications for radiotherapy of liver tumors. However, because of poor tolerance to hepatic radiation, estimation of the intensity of irradiation of the liver is important, particularly for a cirrhotic liver. Knowledge of radiation-induced hepatitis is important for understanding how to optimize hepatic radiation therapy. Pathological changes of the irradiated liver, which include perivenular fibrosis, sinusoidal obstruction, and damage to Kupffer cells and hepatocytes, can be visualized using clinical imaging techniques. This review article discusses and illustrates the pathological and radiological changes of hepatic tumors and the surrounding parenchyma of the irradiated liver.

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confidence: 99%

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confidence: 99%

Pathology and images of radiation-induced hepatitis: a review article

et al. 2018

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“…We also did not identify the risk factors with a multivariate analysis. From a statistical point of view, previous reports failed to detect risk factors among the dose-function parameters because patients with RILD as an endpoint were too few to analyze with multivariate analysis and each dose-liver function parameter was not an independent variable but correlated with the other variables [3][4][5] . Therefore, instead of a multivariate analysis, we used a ROC analysis with individual monovariable analyses to assess each dose-liver function parameter, which allowed us to calculate the cutoff values with great exactness.…”

Section: Discussionmentioning

confidence: 99%

“…Only two cutoff values are available for predicting RILD. Kim et al proposed using the total liver volume, with a cutoff value for TLV30Gy (percentage of the total liver volume receiving ≥30 Gy) of 60% to predict RILD [5] . However, this value does not reflect liver function and is not applicable to giant HCC.…”

Section: Introductionmentioning

confidence: 99%

Cutoff Values for Dose-liver Function Parameters to Prevent Radiation-induced Liver Disease in Advanced Hepatoma

Shirai

Kumayama

Sato

et al. 2015

Journal of Gastroenterology and Hepatology Research

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AIM:To retrospectively explore the cutoff values that predict radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) in the main trunk and/or the first branch who had previously received singlephoton-emission computed tomography (SPECT)-based threedimensional conformal radiotherapy (3DCRT; SPECT-B-3DCRT) using Tc-99m-galactosyl human serum albumin (Tc-99m GSA). METHODS: Seventy-five HCC patients with PVTT underwent SPECT-B-3DCRT (total dose of 45 Gy/18 fractions) in the stopbreathing position with an error of ≤5 mm. SPECT allowed the minimum possible irradiation of the functional liver (FL). ChildPugh score deterioration (CPSD) by 2 (=RILD) or CPSD by 1 was scored within four months of completing SPECT-B-3DCRT. Receiver-operating characteristic (ROC) analysis of the outcomes RILD vs CPSD by 1 was conducted to determine the accuracy and cutoff values for FLV20Gy (percentage of FL volume receiving ≥20 Gy), F20Gy (GSA counts within the irradiated liver area receiving ≥20 Gy ×100/GSA counts in the whole liver), F20Gy/LHL15 (liver radioactivity counts at 15 min/heart plus liver radioactivity counts at 15 min), and F20Gy/total count ratio (liver radioactivity counts/liver plus total background radioactivity counts). RESULTS:The cutoff values and accuracy of FLV20Gy, F20Gy, F20Gy/ LHL15, and F20Gy/total count ratio were 26.4 and 0.826 (p=0.024), 30.2 and 0.913 (p=0.004), 37.7 and 0.913 (p=0.001), and 43.0 and 0.957 (p<0.001), respectively. CONCLUSION: An F20Gy/total count ratio of 43.0 is the most reliable cutoff value for preventing RILD.

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“…There are several reports dealing with the relationship between the dosimetric data and radiation-induced toxicities in a variety of organs, such as the lung, liver, and esophagus (Graham et al 1999;Takeda et al 2006;Kim et al 2007). It has been reported that dosimetric factors, such as mean lung dose (MLD), the percentage of CT-defined total lung volume receiving > 20 Gy (V20) and > 30 Gy (V30), and normal tissue complication probability (NTCP) are strongly related to the development of RP (Armstrong et al 1995;Kwa et al 1998;Graham et al 1999;Hernando et al 2001).…”

Section: Treatment Proceduresmentioning

confidence: 99%

Dosimetric Factors Used for Thoracic X-Ray Radiotherapy are not Predictive of the Occurrence of Radiation Pneumonitis after Carbon-Ion Radiotherapy

Koto

Tsujii²,

Yamamoto³

et al. 2007

Tohoku J. Exp. Med.

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Radiation pneumonitis (RP) is one of the most common dose-limiting toxicities in thoracic X-ray radiotherapy (XRT). Dosimetric factors are used for prediction of the occurrence of RP after XRT. Carbon-ion radiotherapy (CRT) is a promising modality because of its excellent dose localization and high biological effect on tumors. This study aims to analyze the relationship between dosimetric factors developed for XRT and the incidence of RP in patients with stage I non-small cell lung cancer (NSCLC) after CRT. We examined 80 inoperable patients with NSCLC. The ranges of the daily fraction sizes and the total doses were from 3.3 to 8.8 GyE and from 59.4 to 95.4 GyE, respectively. These doses were successfully delivered with acceptable toxicity; grade 2 RP was observed in 8 patients (10%). The severity of RP was graded within 6 months of the initiation of CRT using the Radiation Therapy Oncology Group criteria. These results indicate the excellent dose distribution of CRT. We then compared the dosimetric data of the 8 patients developed grade 2 RP with those of 72 patients developed grade 1 RP. Dosimetric factors useful for predicting RP in XRT, such as the percentage of the computed tomography-defined total lung volume receiving > 5, > 20, and > 30 GyE, and mean lung dose, were not predictive factors for RP after CRT. The dosimetric factors used for XRT are not applicable for CRT in patients with NSCLC. The dosimetric factors for CRT remain to be developed.non-small cell lung cancer; carbon-ion radiotherapy; radiation pneumonitis; dosimetric factor; normal tissue

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Dose–volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy

Cited by 138 publications

References 22 publications

Pathology and images of radiation-induced hepatitis: a review article

Pathology and images of radiation-induced hepatitis: a review article

Cutoff Values for Dose-liver Function Parameters to Prevent Radiation-induced Liver Disease in Advanced Hepatoma

Dosimetric Factors Used for Thoracic X-Ray Radiotherapy are not Predictive of the Occurrence of Radiation Pneumonitis after Carbon-Ion Radiotherapy

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