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

Kim TH, Kim DY, Park JW, Kim SH, Choi JI, Kim HB, Lee WJ, Park SJ, Hong EK, Kim CM

Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.

PURPOSE: To identify the dose-volumetric parameters associated with the risk of radiation-induced hepatic toxicity (RIHT) in hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy. METHODS AND MATERIALS: A total of 105 hepatocellular carcinoma patients underwent three-dimensional conformal radiotherapy (total dose range, 44-58.5 Gy; median, 54). RIHT was scored within 4 months of completing three-dimensional conformal radiotherapy. The dose-volume parameters analyzed were the gross tumor volume; normal liver volume; total liver volume; radiation dose; mean dose to the normal liver; percentage of the normal liver volume receiving > or =20, > or =25, > or =30, > or =35, and > or =40 Gy; percentage of the total liver volume receiving > or =20, > or =25, > or =30, > or =35, and > or =40 Gy; and the normal tissue complication probability. RESULTS: Of the 105 patients, Grade 1 RIHT was observed in 21 (20.0%), Grade 2 in 7 (6.7%), Grade 3 in 5 (4.8%), and Grade 4 in 1 (1.0%) patient. No fatal Grade 5 RIHT developed. On multivariate analysis for predicting Grade 2 or worse RIHT, the total liver volume receiving > or =30 Gy was the only significant parameter (p < 0.001). Grade 2 or worse RIHT was observed in only 2 (2.4%) of 85 patients with a total liver volume receiving 30 Gy of < or =60% and in 11 (55.0%) of 20 patients with >60% (p < 0.001). CONCLUSION: The total liver volume receiving > or =30 Gy appears to be a useful dose-volumetric parameter for predicting the risk of RIHT. This volume should be limited to < or =60% whenever possible to minimize the risk of Grade 2 or worse RIHT.

Published 25 December 2006 in Int J Radiat Oncol Biol Phys, 67(1): 225-31.
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