The Safety Indicator of Radiotherapy for Advanced Hepatoma with Liver Cirrhosis

Abstract

AIM: To identify the dose-volumetric parameters (DVPs) associated with the risk of radiation-induced liver disease (RILD) or Child– Pugh score deterioration (CPSD) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) treated with single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B 3DCRT). METHODS: A total of 64 HCC patients with PVTT underwent SPECT-B3DCRT (total dose of 45 Gy/18 fractions). SPECT using Tc-99m-galactosyl human serum albumin enabled the minimum possible irradiation of functional liver (FL). RILD or CPSD was scored within 4 months of completing SPECT-B3DCRT. The following DVPs were analyzed: mean dose to FL; mean dose to normal liver (NL); percentage of FL volume receiving≥20, ≥25, and≥30 Gy; percentage of NL volume receiving≥20, ≥25, and ≥ 30 Gy; and percentage of total liver volume receiving≥20, ≥25, and ≥30 Gy. RESULTS: Of the 64 patients, RILD or CPSD by 1 was observed in 3 (4.7%) or 12 (18.8%) patients, respectively. Multivariate analysis for predicting RILD or CPSD revealed FL volume receiving≥20 Gy (FLV20Gy) as the only significant parameter (p<0.001). The observed rates of FLV20Gy≤20% and FLV20Gy>20% for RILD or CPSD by 1 were 4.5% (2/44) and 65% (13/20), respectively (p<0.001). CONCLUSION: FLV20Gy≤20% appears to be a predictive indicator for avoiding the risk of RILD or CPSD by 1.