Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;33(6):1093-1102.
doi: 10.3904/kjim.2016.412. Epub 2017 Aug 28.

Clinical significance of radiation-induced liver disease after stereotactic body radiation therapy for hepatocellular carcinoma

Baek Gyu Jun  1 , Young Don Kim  1 , Gab Jin Cheon  1 , Eun Seog Kim  2 , Eunjin Jwa  2 , Sang Gyune Kim  3 , Young Seok Kim  3 , Boo Sung Kim  3 , Soung Won Jeong  4 , Jae Young Jang  4 , Sae Hwan Lee  5 , Hong Soo Kim  5
Affiliations

Clinical significance of radiation-induced liver disease after stereotactic body radiation therapy for hepatocellular carcinoma

Baek Gyu Jun et al. Korean J Intern Med. 2018 Nov.

Abstract

Background/aims: The aim of this study was to investigate parameters that predict radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to identify the clinical significance of RILD.

Methods: We retrospectively reviewed the medical records of 117 HCC patients who were treated by SBRT from March 2011 to February 2015. RILD was defined as elevated liver transaminases more than five times the upper normal limit or a worsening of Child-Pugh (CP) score by 2 within 3 months after SBRT. All patients were assessed at 1 month and every 3 months after SBRT.

Results: Median follow-up was 22.5 months (range, 3 to 56) after SBRT. RILD was developed in 29 of the 117 patients (24.7%). On univariate analysis, significant predictive factors of RILD were pretreatment CP score (p < 0.001) and normal liver volume (p = 0.002). Multivariate analysis showed that CP score was a significant predictor of RILD (p < 0.001). The incidence of RILD increased above a CP score of 6 remarkably. The rate of recovery from RILD decreased significantly above a CP score of 8. Survival analysis showed that CP score was an independent prognostic factor of overall survival (p = 0.001).

Conclusion: CP score is a significant factor to predict RILD in patients with chronic liver disease. RILD can be tolerated by patients with a CP score ≤ 7. However, careful monitoring of liver function is needed for patients with a CP score 7 after SBRT.

Keywords: Carcinoma, hepatocellular; Child-Pugh score; Radiation-induced liver disease; Stereotactic body radiation therapy.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Probability of radiation-induced liver disease (RILD) and recovery from RILD according to Child-Pugh (CP) score. The probability of RILD gradually increased and the probability of recovery from RILD decreased along with an increase in CP score (p < 0.001).
Figure 2.
Figure 2.
Change in Child-Pugh (CP) score within 6 months after stereotactic body radiotherapy (SBRT). The change in CP score at 3 months after SBRT gradually increased along with an increase in the pretreatment CP score (one-way analysis of variance, p < 0.001). The change in CP score was 0.27, 0.68, 1.29, 2.2, and 2.5 at a CP score of 5, 6, 7, 8, and 9 at 3 months, respectively.
See this image and copyright information in PMC

References

    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–2917. - PubMed
    1. Ikai I, Kudo M, Arii S, et al. Report of the 18th follow-up survey of primary liver cancer in Japan. Hepatol Res. 2010;40:1043–1059. - PubMed
    1. Sheu JC, Huang GT, Chen DS, et al. Small hepatocellular carcinoma: intratumor ethanol treatment using new needle and guidance systems. Radiology. 1987;163:43–48. - PubMed
    1. Ikeda K, Kumada H, Saitoh S, Arase Y, Chayama K. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma: an analysis by the Cox proportional hazard model. Cancer. 1991;68:2150–2154. - PubMed
    1. Lawrence TS, Robertson JM, Anscher MS, Jirtle RL, Ensminger WD, Fajardo LF. Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys. 1995;31:1237–1248. - PubMed

MeSH terms

LinkOut - more resources