RADIOTHERAPEUTIC PARAMETERS PREDICTIVE OF LIVER COMPLICATIONS INDUCED BY LIVER TUMOR RADIOTHERAPY
RADIOTHERAPEUTIC PARAMETERS PREDICTIVE OF LIVER COMPLICATIONS INDUCED BY LIVER TUMOR RADIOTHERAPY
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DOI：
10.1016/j.ijrobp.2008.04.035
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发表时间：
2009-01-01
影响因子：
7
通讯作者：
Han, Kwang Hyub
中科院分区：
文献类型：
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作者：
Lee, Ik Jae;Seong, Jinsil;Han, Kwang Hyub
目的：探讨预测肝肿瘤放疗后肝脏并发症的放射治疗参数。方法与材料：2001-2003年间，131例肝细胞癌患者接受三维适形放射治疗。总剂量由非肿瘤肝脏接受等中心剂量的50%(V-50%)的部分确定。我们使用非肿瘤性肝脏体积或非肿瘤性肝脏体积和肝功能储备的组合来评估已发表的三套放射剂量指南。根据密歇根大学和延世大学的指导方针，V-50%被分为三个区间(66%)和四个类别(75%)。结果：131例患者中，13例(9.9%)出现肝脏并发症。AVS<33%、33%~66%和66%以上的发生率分别为11.1%、10.3%和18.2%。观察到的肝毒性发生率分别为10%、12.1%和10.4%，分别小于25%、25%~49%和50%~75%。非肿瘤肝脏体积和ICG-R15不是肝脏并发症的预测因子。肝功能分级B级患者肝脏并发症发生率明显增加(p=0.044)。结论：V-50%可分为4类，可用于预测可接受的毒性。此外，肝功能状况的指标，如Child-Pugh分级，可能是比ICG-R15更重要和更有用的参数来预测与辐射相关的肝病。(C)2009年爱思唯尔公司。
Purpose: The purpose of this study was to identify radiotherapeutic parameters for predicting the occurrence of liver complications induced by radiotherapy of a liver tumor.Methods and Materials: From 2001 to 2003, a total of 131 patients with hepatocellular carcinoma received three-dimensional conformal radiotherapy. The total dose was determined by the fraction of nontumor liver receiving 50% of the isocenter dose (V-50%). We evaluated three sets of published radiation dose guidelines using nontumor liver volume or a combination of nontumor liver volume and hepatic functional reserve. The V-50% was divided into three intervals (66%) and four categories (75 %) according to guidelines by the University of Michigan and the Yonsei University, respectively. According to the guideline of Cheng et al., the radiation dose was determined by the indocyanin green retention rate at 15 min (ICG-R15) and the nontumor liver volume.Results: Of the 131 patients, 13 patients (9.9%) presented with liver complications. The incidence was 11.1 %, 10.3%, and 18.2%, respectively, for a VS, of less than 33%, 33% to 66%, and more than 66%. The observed hepatic toxicity incidence was 10%, 12.1%, and 10.4% respectively for a VS, of less than 25%, 25% to 49%, and 50% to 75%, respectively. Nontumor liver volume and ICG-R15 were not predictors of liver complications. The incidence of liver complications was significantly increased in patients with Child-Pugh Class B (p = 0.044).Conclusions: The parameter, V-50% can be divided into 4 categories and used to predict acceptable toxicity. Furthermore, indicators of liver functional status like the Child-Pugh class may be more important and useful parameters than ICG-R15 for predicting radiation-related liver disease. (C) 2009 Elsevier Inc.