Dosimetric predictor identification for radiation-induced liver disease after hypofractionated conformal radiotherapy for primary liver carcinoma patients with Child–Pugh Grade A cirrhosis

Liang, S.; Huang, Xiao; Zhu, Xiao Dong; Zhang, Wensheng; Cai, Luyao; Huang, Hua; Li, Ye Fei; Chen, Long; Liu, Meng Zhong

doi:10.1016/j.radonc.2010.10.014

Cited by 62 publications

(54 citation statements)

References 19 publications

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“…Classic RILD is a subacute hepatic toxicity that presents with anicteric ascites, hepatomegaly, and elevated alkaline phosphatase levels; it typically occurs between 4 and 8 weeks after the completion of RT [5,22]. Previously, classic RILD was a serious problem that could occur in response to radiation amounts of 30–35 Gy to the whole liver; however, the incidence decreased after partial volume irradiation became more frequently used [13,14]. Kim et al [10] considered an increase in hepatic enzymes above grade 2 to be RIHT according to the Common Terminology Criteria for Adverse Events (CTCAE) criteria.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, the CP score is appropriate for evaluation of hepatic function, and an increase of at least 2 points in the CP score can be viewed as an important factor with which to evaluate hepatic toxicity after RT. Moreover, classic RILD and RIHT-related studies report the occurrence of this toxicity within 3–4 months [10,11,13,17,22]. Therefore, it is reasonable to consider an increase of at least 2 points in the CP score within 3 months to be RIHT.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the CP score was monitored for 3 months. Although a shorter follow-up duration for the CP score after the completion of RT could reduce the risk of influence of natural deterioration of liver cirrhosis, a 3-month follow-up duration was necessary in order to evaluate RT-induced CP score increases according to previous studies [10,11,13,17,19]. Moreover, we evaluated the laboratory results immediately prior to other treatments to prevent errors caused by the transient elevation of CP scores if additional treatments were performed within the 3-month period after RT.…”

Section: Discussionmentioning

confidence: 99%

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Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Son

Jang

et al. 2014

Radiat Oncol

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BackgroundWe attempted to analyze the effects of an increase in the Child-Pugh (CP) score on the overall survival of patients with unresectable hepatocellular carcinoma (HCC) after radiotherapy (RT).MethodsFrom March 2006 to February 2012, 103 patients received RT using the TomoTherapy Hi-Art at Incheon St. Mary’s Hospital and Seoul St. Mary’s Hospital. The dose per fraction was 1.8–5 Gy, and the total dose was 40–60 Gy (median, 50 Gy). We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.ResultsThe median follow-up duration was 11.6 months (range, 3.5–85.3 months). The median survival time was 11.6 months. In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively). In a comparison of cases with and without an increase in the CP score, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.ConclusionAn increase of at least 2 points in the CP score within 3 months of RT completion is an important on-treatment factor that affects overall survival. To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Son

Jang

et al. 2014

Radiat Oncol

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“…Radiation induced liver disease (RILD), a dreadful complication associated with increased risk of death, has been reported even after very limited radiation doses with 2-dimensional RT technique [28]. Liver cirrhosis which is usually related to the development of HCC is a likely reason that the liver is more fragile to RT [29]. Due to the importance of maintaining good liver function in the management of HCC, until recently, RT could not be justified against this background.…”

Section: Ebrt In Hccmentioning

confidence: 99%

“…More comprehensive research on RILD after RT also became possible with dose-volume histogram analysis from 3D-CRT planning [13][14][15]29]. With a deeper understanding of the occurrence RILD and more conformal delivery of RT, RILD has become rarely reported in the recent liver-centric RT literature.…”

Section: Techniques Of Ebrtmentioning

confidence: 99%

Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials

Park

Cheng

et al. 2016

Liver Cancer

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A consensus meeting to develop practice guidelines and to recommend future clinical trials for radiation therapy (RT), including external beam RT (EBRT), and selective internal RT (SIRT) in hepatocellular carcinoma (HCC) was held at the 5th annual meeting of the Asia-Pacific Primary Liver Cancer Expert consortium. Although there is no randomized phase III trial evidence, the efficacy and safety of RT in HCC has been shown by prospective and retrospective studies using modern RT techniques. Based on these results, the committee came to a consensus on the utility and efficacy of RT in the management of HCC according to each disease stage as follows: in early and intermediate stage HCC, if standard treatment is not compatible, RT, including EBRT and SIRT can be considered. In locally advanced stage HCC, combined EBRT with transarterial chemoembolization or hepatic arterial infusion chemotherapy, and SIRT can be considered. In terminal stage HCC, EBRT can be considered for palliation of symptoms and reduction of morbidity caused by the primary tumor or its metastases. Despite the currently reported benefits of RT in HCC, the committee agreed that there is a compelling need for large prospective studies, including randomized phase III trial evidence evaluating the role of RT. Specifically studies evaluating the efficacy and safety of sequential combination of EBRT and SIRT are strongly recommended.

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Correlation of chemokines and growth factors with radiation-induced liver injury after interstitial high dose rate (HDR) brachytherapy of liver metastases

Damm

Pech

Cavalli

et al. 2022

J Cancer Res Clin Oncol

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Background Locoregional therapies, as imaging-guided tumor-directed procedures, are emerging treatment strategies in the management of primary and secondary liver malignancies such as e.g. colorectal cancer liver metastases. As one of those, irradiation-based interstitial high dose rate brachytherapy (iBT) of liver metastases bears a risk of developing focal radiation-induced liver injury (fRILI). Since little is known about biological factors involved in hepatic dysfunction after irradiation, the aim of this study was to identify factors, that may play a role in the underlying mechanism of fRILI, and that potentially may serve as biomarkers for post-therapeutic fRILI to improve specific management and treatment of patients. Methods Twenty-two patients with hepatic malignancies (tumor patients, TP) underwent iBT with total ablative doses of radiation to the target volume ranging from e.g. 15 to 25 Gy. Hepatobiliary magnetic resonance imaging (MRI) was performed 6 weeks after iBT to quanitify fRILI. Blood samples were taken before (pre) and 6 weeks after (post) iBT from TP, and from ten healthy volunteers (HV controls) for the analyses of humoral mediators: monocyte chemoattractant protein-1 (MCP-1), chemokine (C-X3-C motif) ligand 1 (CX3CL1), vascular endothelial growth factor (VEGF) and beta-nerve growth factor (beta-NGF) using the Multi-Analyte Flow Assay via flow cytometry. Correlation analyses between the humoral mediators (pre and post iBT) with the tumor volume and fRILI were performed. Results While MCP-1 and CX3CL1 tended to decrease in TP vs. HV, VEGF was significantly decreased in TP vs. HV pre and post iBT (p < 0.05). Beta-NGF levels were significantly increased in TP vs. HV pre and post iBT (p < 0.05). Baseline circulating levels of MCP-1, VEGF and beta-NGF have shown significant positive correlations with the hepatic tumor volume (p < 0.05). Circulating levels of humoral mediators before treatment did not correlate with fRILI, while CX3CL1 and VEGF after iBT have shown significant positive correlations with fRILI (p < 0.05). Conclusion Tumor volume and threshold dose of irradiation damage correlated positively with MCP-1 and VEGF as well as NGF and CX3CL, respectively. Thus, investigation of biological mediators in blood samples from tumor patients may provide an appropriate tool to predict fRILI after interstitial HDR brachytherapy of liver metastases.

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Dosimetric predictor identification for radiation-induced liver disease after hypofractionated conformal radiotherapy for primary liver carcinoma patients with Child–Pugh Grade A cirrhosis

Cited by 62 publications

References 19 publications

Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials

Correlation of chemokines and growth factors with radiation-induced liver injury after interstitial high dose rate (HDR) brachytherapy of liver metastases

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