Biologic susceptibility of hepatocellular carcinoma patients treated with radiotherapy to radiation-induced liver disease
Journal
International Journal of Radiation Oncology Biology Physics
Journal Volume
60
Journal Issue
5
Pages
1502-1509
Date Issued
2004
Author(s)
Abstract
Purpose: To identify the factors associated with radiation-induced liver disease (RILD) and to describe the difference in normal tissue complication probability (NTCP) between subgroups of hepatocellular carcinoma patients undergoing three-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: A total of 89 hepatocellular carcinoma patients who completed 3D-CRT for local hepatic tumors were included. The average isocenter dose was 49.9 ± 6.2 Gy. Logistic regression analysis was used for the association between statistically significant factors and RILD (defined as Grade 3 or 4 hepatic toxicity of elevated transaminases or alkaline phosphatase within 4 months of completing 3D-CRT) in multivariate analysis. Maximal likelihood analysis was conducted to obtain the best estimates of the NTCP model parameters. Results: Of the 89 patients, 17 developed RILD. In univariate analysis, hepatitis B virus (HBV)-positive status and the mean radiation dose to the liver were the two factors significantly associated with the development of RILD. Of the 65 patients who were HBV carriers, 16 had RILD compared with 1 of 24 non-carrier patients (p = 0.03). The mean radiation dose to liver was significantly greater in patients with RILD (22.9 vs. 19.0 Gy, p = 0.05). On multivariate analysis, HBV carrier status (odds ratio, 9.26; p = 0.04) and Child-Pugh B cirrhosis of the liver (odds ratio, 3.65; p = 0.04) remained statistically significant. The best estimates of the NTCP parameters were n = 0.35, m = 0.39, and TD 50(1) = 49.4 Gy. The n, m, TD 50(1) specifically estimated from the HBV carriers was 0.26, 0.40, and 50.0 Gy, respectively, compared with 0.86, 0.31, and 46.1 Gy, respectively, for non-carrier patients. Conclusion: Hepatocellular carcinoma patients who were HBV carriers or had Child-Pugh B cirrhosis presented with a statistically significantly greater susceptibility to RILD after 3D-CRT. ? 2004 Elsevier Inc.
Subjects
Hepatitis B virus carrier; Hepatocellular carcinoma; Normal tissue complication probability; Radiation-induced liver disease
SDGs
Other Subjects
Biological susceptibility; Normal tissue complication probability (NTCP); Radiation-induced liver disease (RILD); Three-dimensional conformal radiotheraphy (3D-CRT); Diseases; Dosimetry; Enzymes; Mathematical models; Maximum likelihood estimation; Multivariable systems; Oncology; Tissue; Tumors; Radiotherapy; alkaline phosphatase; aminotransferase; adult; aged; article; cancer patient; cancer radiotherapy; controlled study; disease association; disease course; disease predisposition; female; health status; Hepatitis B virus; human; liver cell carcinoma; liver cirrhosis; liver disease; liver toxicity; logistic regression analysis; major clinical study; male; multivariate analysis; priority journal; probability; radiation dose; radiation injury; statistical model; virus carrier; Adult; Aged; Analysis of Variance; Carcinoma, Hepatocellular; Carrier State; Disease Susceptibility; Female; Hepatitis B, Chronic; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Radiation Injuries; Radiotherapy Dosage; Radiotherapy, Conformal
Type
journal article