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( Baek Gyu Jun ),( Young Don Kim ),( Gab Jin Cheon ),( Eun Seog Kim ),( Eunjin Jwa ),( Sang Gyune Kim ),( Young Seok Kim ),( Boo Sung Kim ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Ho 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.6
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). Conclusions: 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.
Jung, Jinhong,Yoon, Sang Min,Kim, So Yeon,Cho, Byungchul,Park, Jin-hong,Kim, Su Ssan,Song, Si Yeol,Lee, Sang-wook,Ahn, Seung Do,Choi, Eun Kyung,Kim, Jong Hoon BioMed Central 2013 Radiation oncology Vol.8 No.-
<P><B>Background</B></P><P>To investigate the clinical and dose–volumetric parameters that predict the risk of radiation-induced liver disease (RILD) for patients with small, unresectable hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT).</P><P><B>Methods</B></P><P>Between March 2007 and December 2009, 92 patients with HCC treated with SBRT were reviewed for RILD within 3 months of completing treatment. RILD was evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. A dose of 10–20 Gy (median, 15 Gy) per fraction was given over 3–4 consecutive days for a total dose of 30–60 Gy (median, 45 Gy). The following clinical and dose–volumetric parameters were examined: age, gender, Child-Pugh class, presence of hepatitis B virus, gross tumor volume, normal liver volume, radiation dose, fraction size, mean dose to the normal liver, and normal liver volumes receiving from < 5 Gy to < 60 Gy (in increments of 5 Gy).</P><P><B>Results</B></P><P>Seventeen (18.5%) of the 92 patients developed grade 2 or worse RILD after SBRT (49 patients in grade 1, 11 in grade 2, and 6 in ≥ grade 3). On univariate analysis, Child-Pugh class was identified as a significant clinical parameter, while normal liver volume and normal liver volumes receiving from < 15 Gy to < 60 Gy were the significant dose–volumetric parameters. Upon multivariate analysis, only Child-Pugh class was a significant parameter for predicting grade 2 or worse RILD.</P><P><B>Conclusions</B></P><P>The Child-Pugh B cirrhosis was found to have a significantly greater susceptibility to the development of grade 2 or worse RILD after SBRT in patients with small, unresectable HCC. Additional efforts aimed at testing other models to predict the risk of RILD in a large series of HCC patients treated with SBRT are needed.</P>
( Baek Gyu Jun ),( Young Don Kim ),( Gab Jin Cheon ),( Sae Hwan Lee ),( Hong Soo Kim ),( Sang Gyune Kim ),( Young Seok Kim ),( Boo Sung Kim ),( Soung Won Jeong ),( Jae Young Jang ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The aim of this study was to identify parameters that predict radiation induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in cirrhotic patients with small hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed 84 patients treated with SBRT for small (diameter <3 cm) HCC treated by SBRT between March 2011 and February 2015. RILD was defined as elevated liver transaminases more than five times the upper limit of normal or a worsening of Child-Pugh 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 16.5 (2-56) months after SBRT. Seventeen (18.5%) of the 84 patients developed RILD after SBRT. Multivariate logistic regression analysis showed that Child-Pugh (CP) scores (p < 0.01) was significant parameter to predict RILD in cirrhotic patients. According to linear by linear association model, as CP score increases, the incidence rate of RILD (P<0.01) increases, and the recov- ery rate of RILD (P<0.01) shows a tendency to decrease. The incidence rate of RILD increases at CP score 6 remarkably, and the recovery rate of RILD seems to decrease significantly at CP score 8. In multivariate analysis, CP score 8 was independent prognostic factors of overall survival. (P<0.01) Conclusions: CP score is important factor to predict RILD. The Incidence rate of RILD seems to increase, but does not recover at CP score above 8.