Liang Shi-Xiong, Zhu Xiao-Dong, Xu Zhi-Yong, Zhu Ji, Zhao Jian-Dong, Lu Hai-Jie, Yang Yun-Li, Chen Long, Wang An-Yu, Fu Xiao-Long, Jiang Guo-Liang
Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China.
Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):426-34. doi: 10.1016/j.ijrobp.2005.12.031.
To identify risk factors relevant to radiation-induced liver disease (RILD) and to determine the hepatic tolerance to radiation.
The data of 109 primary liver carcinomas (PLC) treated with hypofractionated three-dimensional conformal radiation therapy (3D-CRT) were analyzed. Seventeen patients were diagnosed with RILD and 13 of 17 died of it.
The risk factors for RILD were late T stage, large gross tumor volume, presence of portal vein thrombosis, association with Child-Pugh Grade B cirrhosis, and acute hepatic toxicity. Multivariate analyses demonstrated that the severity of hepatic cirrhosis was a unique independent predictor. For Child-Pugh Grade A patients, the hepatic radiation tolerance was as follows: (1) Mean dose to normal liver (MDTNL) of 23 Gy was tolerable. (2) For cumulative dose-volume histogram, the tolerable volume percentages would be less than: V5 of 86%, V10 of 68%, V15 of 59%, V20 of 49%, V25 of 35%, V30 of 28%, V35 of 25%, and V40 of 20%. (3) Tolerable MDTNL could be estimated by MDTNL (Gy) = -1.686 + 0.023 * normal liver volume (cm3).
The predominant risk factor for RILD was the severity of hepatic cirrhosis. The hepatic tolerance to radiation could be estimated by dosimetric parameters.
确定与放射性肝病（RILD）相关的危险因素，并确定肝脏对辐射的耐受性。
分析了109例接受大分割三维适形放射治疗（3D-CRT）的原发性肝癌（PLC）患者的数据。17例患者被诊断为RILD，其中13例死于该病。
RILD的危险因素包括T分期较晚、肿瘤大体体积较大、存在门静脉血栓形成、合并Child-Pugh B级肝硬化以及急性肝毒性。多因素分析表明，肝硬化的严重程度是唯一的独立预测因素。对于Child-Pugh A级患者，肝脏的辐射耐受性如下：（1）正常肝脏平均剂量（MDTNL）23 Gy是可耐受的。（2）对于累积剂量体积直方图，可耐受的体积百分比应小于：V5为86%，V10为68%，V15为59%，V20为49%，V25为35%，V30为28%，V35为25%，V40为20%。（3）可通过MDTNL（Gy）=-1.686 + 0.023×正常肝脏体积（cm³）估算可耐受的MDTNL。
RILD的主要危险因素是肝硬化的严重程度。肝脏对辐射的耐受性可通过剂量学参数进行估算。
