The Safety Indicator of Radiotherapy for Advanced Hepatoma with Liver Cirrhosis

Shintaro Shirai, Morio Sato, Yasutaka Noda, Yoshitaka Kumayama, Tetsuo Sonomura, Nobuyuki Kawai, Hiroki Minamiguchi, Motoki Nakai, Hiroki Sanda, Fumihiro Tanaka

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.

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