Stereotactic Body Radiotherapy for Patients with Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication
Received 2 July 2009; received in revised form 4 September 2009; accepted 4 September 2009. published online 08 March 2010. Corrected Proof
Purpose
To identify the parameters that predict hepatic toxicity and deterioration of hepatic function.
Materials and Methods
A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those, 36 patients received no other local treatments that could influence hepatic toxicity at least for 3 months after the completion of SBRT. The gross tumor volume (GTV) was 18.3 ± 15.9 cm3 (range, 3.0–81.3 cm3), and the total dose administered was 30–39 Gy (median, 36 Gy). To assess the deterioration of hepatic function, we evaluated the presence or absence of the progression of Child-Pugh class (CP class). To identify the parameters of predicting the radiation-induced hepatic toxicity and deterioration of the hepatic function, several clinical and dose-volumetric parameters were evaluated.
Results
Of 36 patients, 12 (33%) developed Grade 2 or higher hepatic toxicity and 4 (11%) developed progression of CP class. The multivariate analysis showed that the only significant parameter associated with the progression of CP class was the total liver volume receiving a dose less than 18 Gy (<18 Gy).
Conclusions
The progression of CP class after SBRT limits other additional local treatments and also reflects the deterioration of hepatic function. Therefore, it would be important to note that the presence or absence of the progression of CP class is a dose-limiting factor. The total liver volume receiving <18 Gy should be greater than 800 cm3 to reduce the risk of the deterioration of hepatic function.
∗Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
†Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
‡Cyberknife Center of Gimpo Wooridul Spine Hospital, Seoul, Korea
§Department of Radiation Oncology, College of Medicine, Gyeongsang National University, Jinju, Korea
Reprint requests to: Hong Seok Jang, M.D., Depart. of Radiation Oncology, Seoul St. Mary's Hospital, 505, Banpo-dong, Seocho-gu, Seoul, Korea. Tel: 82-2-2258-6257; Fax: 82-2-2258-1532
ABSTRACT