Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication
Purpose To identify the parameters that predict hepatic toxicity and deterioration of hepatic function. Materials and Methods A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those...
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| creator | Son, Seok Hyun, M.D Choi, Byung Ock, M.D Ryu, Mi Ryeong, M.D Kang, Young Nam, Ph.D Jang, Ji Sun, M.S Bae, Si Hyun, M.D Yoon, Seung Kew, M.D Choi, Ihl Bohng, M.D Kang, Ki Mun, M.D Jang, Hong Seok, M.D |
| description | Purpose To identify the parameters that predict hepatic toxicity and deterioration of hepatic function. Materials and Methods A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those, 36 patients received no other local treatments that could influence hepatic toxicity at least for 3 months after the completion of SBRT. The gross tumor volume (GTV) was 18.3 ± 15.9 cm3 (range, 3.0–81.3 cm3 ), and the total dose administered was 30–39 Gy (median, 36 Gy). To assess the deterioration of hepatic function, we evaluated the presence or absence of the progression of Child-Pugh class (CP class). To identify the parameters of predicting the radiation-induced hepatic toxicity and deterioration of the hepatic function, several clinical and dose-volumetric parameters were evaluated. Results Of 36 patients, 12 (33%) developed Grade 2 or higher hepatic toxicity and 4 (11%) developed progression of CP class. The multivariate analysis showed that the only significant parameter associated with the progression of CP class was the total liver volume receiving a dose less than 18 Gy ( |
| doi_str_mv | 10.1016/j.ijrobp.2009.09.009 |
| format | Article |
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Materials and Methods A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those, 36 patients received no other local treatments that could influence hepatic toxicity at least for 3 months after the completion of SBRT. The gross tumor volume (GTV) was 18.3 ± 15.9 cm3 (range, 3.0–81.3 cm3 ), and the total dose administered was 30–39 Gy (median, 36 Gy). To assess the deterioration of hepatic function, we evaluated the presence or absence of the progression of Child-Pugh class (CP class). To identify the parameters of predicting the radiation-induced hepatic toxicity and deterioration of the hepatic function, several clinical and dose-volumetric parameters were evaluated. Results Of 36 patients, 12 (33%) developed Grade 2 or higher hepatic toxicity and 4 (11%) developed progression of CP class. The multivariate analysis showed that the only significant parameter associated with the progression of CP class was the total liver volume receiving a dose less than 18 Gy (<18 Gy). Conclusions The progression of CP class after SBRT limits other additional local treatments and also reflects the deterioration of hepatic function. Therefore, it would be important to note that the presence or absence of the progression of CP class is a dose-limiting factor. The total liver volume receiving <18 Gy should be greater than 800 cm3 to reduce the risk of the deterioration of hepatic function.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2009.09.009</identifier><identifier>PMID: 20207492</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; BODY ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - surgery ; CARCINOMAS ; Child-Pugh class (CP class) ; Cyberknife ; DIGESTIVE SYSTEM ; DISEASES ; Female ; GLANDS ; Hematology, Oncology and Palliative Medicine ; Hepatocellular carcinoma ; Hepatocellular carcinoma (HCC) ; HEPATOMAS ; Humans ; LIVER ; Liver - physiopathology ; Liver - radiation effects ; Liver Neoplasms - pathology ; Liver Neoplasms - surgery ; Male ; MEDICINE ; Middle Aged ; Multivariate Analysis ; NEOPLASMS ; NUCLEAR MEDICINE ; ORGANS ; Radiation Injuries - etiology ; Radiation Injuries - physiopathology ; Radiation-induced hepatic toxicity (RIHT) ; RADIOLOGY ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - adverse effects ; Radiosurgery - methods ; RADIOTHERAPY ; Radiotherapy Dosage ; Stereotactic body radiotherapy (SBRT) ; THERAPY ; TOXICITY ; Tumor Burden</subject><ispartof>International journal of radiation oncology, biology, physics, 2010-11, Vol.78 (4), p.1073-1080</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>Copyright © 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-a9fa89f77bc10d90fed7856a78c3710eaaf53ebcd4f7eb66f751d6b633c189173</citedby><cites>FETCH-LOGICAL-c476t-a9fa89f77bc10d90fed7856a78c3710eaaf53ebcd4f7eb66f751d6b633c189173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2009.09.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20207492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/21438042$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Son, Seok Hyun, M.D</creatorcontrib><creatorcontrib>Choi, Byung Ock, M.D</creatorcontrib><creatorcontrib>Ryu, Mi Ryeong, M.D</creatorcontrib><creatorcontrib>Kang, Young Nam, Ph.D</creatorcontrib><creatorcontrib>Jang, Ji Sun, M.S</creatorcontrib><creatorcontrib>Bae, Si Hyun, M.D</creatorcontrib><creatorcontrib>Yoon, Seung Kew, M.D</creatorcontrib><creatorcontrib>Choi, Ihl Bohng, M.D</creatorcontrib><creatorcontrib>Kang, Ki Mun, M.D</creatorcontrib><creatorcontrib>Jang, Hong Seok, M.D</creatorcontrib><title>Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose To identify the parameters that predict hepatic toxicity and deterioration of hepatic function. Materials and Methods A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those, 36 patients received no other local treatments that could influence hepatic toxicity at least for 3 months after the completion of SBRT. The gross tumor volume (GTV) was 18.3 ± 15.9 cm3 (range, 3.0–81.3 cm3 ), and the total dose administered was 30–39 Gy (median, 36 Gy). To assess the deterioration of hepatic function, we evaluated the presence or absence of the progression of Child-Pugh class (CP class). To identify the parameters of predicting the radiation-induced hepatic toxicity and deterioration of the hepatic function, several clinical and dose-volumetric parameters were evaluated. Results Of 36 patients, 12 (33%) developed Grade 2 or higher hepatic toxicity and 4 (11%) developed progression of CP class. The multivariate analysis showed that the only significant parameter associated with the progression of CP class was the total liver volume receiving a dose less than 18 Gy (<18 Gy). Conclusions The progression of CP class after SBRT limits other additional local treatments and also reflects the deterioration of hepatic function. Therefore, it would be important to note that the presence or absence of the progression of CP class is a dose-limiting factor. The total liver volume receiving <18 Gy should be greater than 800 cm3 to reduce the risk of the deterioration of hepatic function.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>BODY</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - surgery</subject><subject>CARCINOMAS</subject><subject>Child-Pugh class (CP class)</subject><subject>Cyberknife</subject><subject>DIGESTIVE SYSTEM</subject><subject>DISEASES</subject><subject>Female</subject><subject>GLANDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Hepatocellular carcinoma</subject><subject>Hepatocellular carcinoma (HCC)</subject><subject>HEPATOMAS</subject><subject>Humans</subject><subject>LIVER</subject><subject>Liver - physiopathology</subject><subject>Liver - radiation effects</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>MEDICINE</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>NEOPLASMS</subject><subject>NUCLEAR MEDICINE</subject><subject>ORGANS</subject><subject>Radiation Injuries - etiology</subject><subject>Radiation Injuries - physiopathology</subject><subject>Radiation-induced hepatic toxicity (RIHT)</subject><subject>RADIOLOGY</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - adverse effects</subject><subject>Radiosurgery - methods</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>Stereotactic body radiotherapy (SBRT)</subject><subject>THERAPY</subject><subject>TOXICITY</subject><subject>Tumor Burden</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks-O1DAMxisEYoeFN0AoEgdOHZymbRoOSMvwZ5FWYsSywC1KU5fJ0CYlSZHmZXhWUnXhwAXJUnL42Z_92Vn2mMKWAq2fH7fm6F07bQsAsV0CxJ1sQxsuclZVX-9mG2A15CzBZ9mDEI4AQCkv72dnBRTAS1Fssl_XET26qHQ0mrxy3Yl8VJ1x8YBeTSfSO0_2Khq0MZAvJh7IjfUYUEfVDkj23ozKn8glTio6jcMwD8qTnfLaWDeqF-S1C5h_dsM8YvRJYq-8Sl_0ISVjZ5Ku_UaS3FojETs3ToPR6e_sw-xer4aAj27f8-zm7ZtPu8v86sO797uLq1yXvI65Er1qRM95qyl0AnrseFPVijeacQqoVF8xbHVX9hzbuu55Rbu6rRnTtBGUs_Ps6VrXhWhk0CaiPmhnbRpUFrRkDZRFop6t1OTdjxlDlKMJy9DKopuDFFVZNVUhmkSWK6m9C8FjL6fVKUlBLuuTR7muTy7rk0uASGlPbgXmdsTub9KffSXg5QpgMuOnQb_0ilYnI_3SaufM_xT-LaAHY5Pbw3c8YTi62dtktKQyFBLk9XJCywWBAJa64Ow3rujGUw</recordid><startdate>20101115</startdate><enddate>20101115</enddate><creator>Son, Seok Hyun, M.D</creator><creator>Choi, Byung Ock, M.D</creator><creator>Ryu, Mi Ryeong, M.D</creator><creator>Kang, Young Nam, Ph.D</creator><creator>Jang, Ji Sun, M.S</creator><creator>Bae, Si Hyun, M.D</creator><creator>Yoon, Seung Kew, M.D</creator><creator>Choi, Ihl Bohng, M.D</creator><creator>Kang, Ki Mun, M.D</creator><creator>Jang, Hong Seok, M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>OTOTI</scope></search><sort><creationdate>20101115</creationdate><title>Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication</title><author>Son, Seok Hyun, M.D ; Choi, Byung Ock, M.D ; Ryu, Mi Ryeong, M.D ; Kang, Young Nam, Ph.D ; Jang, Ji Sun, M.S ; Bae, Si Hyun, M.D ; Yoon, Seung Kew, M.D ; Choi, Ihl Bohng, M.D ; Kang, Ki Mun, M.D ; Jang, Hong Seok, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-a9fa89f77bc10d90fed7856a78c3710eaaf53ebcd4f7eb66f751d6b633c189173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>BODY</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - surgery</topic><topic>CARCINOMAS</topic><topic>Child-Pugh class (CP class)</topic><topic>Cyberknife</topic><topic>DIGESTIVE SYSTEM</topic><topic>DISEASES</topic><topic>Female</topic><topic>GLANDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Hepatocellular carcinoma</topic><topic>Hepatocellular carcinoma (HCC)</topic><topic>HEPATOMAS</topic><topic>Humans</topic><topic>LIVER</topic><topic>Liver - physiopathology</topic><topic>Liver - radiation effects</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>MEDICINE</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>NEOPLASMS</topic><topic>NUCLEAR MEDICINE</topic><topic>ORGANS</topic><topic>Radiation Injuries - etiology</topic><topic>Radiation Injuries - physiopathology</topic><topic>Radiation-induced hepatic toxicity (RIHT)</topic><topic>RADIOLOGY</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - adverse effects</topic><topic>Radiosurgery - methods</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>Stereotactic body radiotherapy (SBRT)</topic><topic>THERAPY</topic><topic>TOXICITY</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Son, Seok Hyun, M.D</creatorcontrib><creatorcontrib>Choi, Byung Ock, M.D</creatorcontrib><creatorcontrib>Ryu, Mi Ryeong, M.D</creatorcontrib><creatorcontrib>Kang, Young Nam, Ph.D</creatorcontrib><creatorcontrib>Jang, Ji Sun, M.S</creatorcontrib><creatorcontrib>Bae, Si Hyun, M.D</creatorcontrib><creatorcontrib>Yoon, Seung Kew, M.D</creatorcontrib><creatorcontrib>Choi, Ihl Bohng, M.D</creatorcontrib><creatorcontrib>Kang, Ki Mun, M.D</creatorcontrib><creatorcontrib>Jang, Hong Seok, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Son, Seok Hyun, M.D</au><au>Choi, Byung Ock, M.D</au><au>Ryu, Mi Ryeong, M.D</au><au>Kang, Young Nam, Ph.D</au><au>Jang, Ji Sun, M.S</au><au>Bae, Si Hyun, M.D</au><au>Yoon, Seung Kew, M.D</au><au>Choi, Ihl Bohng, M.D</au><au>Kang, Ki Mun, M.D</au><au>Jang, Hong Seok, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2010-11-15</date><risdate>2010</risdate><volume>78</volume><issue>4</issue><spage>1073</spage><epage>1080</epage><pages>1073-1080</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose To identify the parameters that predict hepatic toxicity and deterioration of hepatic function. Materials and Methods A total of 47 patients with small unresectable primary hepatocellular carcinoma received hypofractionated stereotactic body radiotherapy (SBRT) using the CyberKnife. Of those, 36 patients received no other local treatments that could influence hepatic toxicity at least for 3 months after the completion of SBRT. The gross tumor volume (GTV) was 18.3 ± 15.9 cm3 (range, 3.0–81.3 cm3 ), and the total dose administered was 30–39 Gy (median, 36 Gy). To assess the deterioration of hepatic function, we evaluated the presence or absence of the progression of Child-Pugh class (CP class). To identify the parameters of predicting the radiation-induced hepatic toxicity and deterioration of the hepatic function, several clinical and dose-volumetric parameters were evaluated. Results Of 36 patients, 12 (33%) developed Grade 2 or higher hepatic toxicity and 4 (11%) developed progression of CP class. The multivariate analysis showed that the only significant parameter associated with the progression of CP class was the total liver volume receiving a dose less than 18 Gy (<18 Gy). Conclusions The progression of CP class after SBRT limits other additional local treatments and also reflects the deterioration of hepatic function. Therefore, it would be important to note that the presence or absence of the progression of CP class is a dose-limiting factor. The total liver volume receiving <18 Gy should be greater than 800 cm3 to reduce the risk of the deterioration of hepatic function.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20207492</pmid><doi>10.1016/j.ijrobp.2009.09.009</doi><tpages>8</tpages></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2010-11, Vol.78 (4), p.1073-1080 |
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| subjects | Adult Aged Aged, 80 and over Analysis of Variance BODY Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - surgery CARCINOMAS Child-Pugh class (CP class) Cyberknife DIGESTIVE SYSTEM DISEASES Female GLANDS Hematology, Oncology and Palliative Medicine Hepatocellular carcinoma Hepatocellular carcinoma (HCC) HEPATOMAS Humans LIVER Liver - physiopathology Liver - radiation effects Liver Neoplasms - pathology Liver Neoplasms - surgery Male MEDICINE Middle Aged Multivariate Analysis NEOPLASMS NUCLEAR MEDICINE ORGANS Radiation Injuries - etiology Radiation Injuries - physiopathology Radiation-induced hepatic toxicity (RIHT) RADIOLOGY RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - adverse effects Radiosurgery - methods RADIOTHERAPY Radiotherapy Dosage Stereotactic body radiotherapy (SBRT) THERAPY TOXICITY Tumor Burden |
| title | Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication |
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