Bae Sun Hyun, Kim Mi-Sook, Jang Won Il, Cho Chul Koo, Yoo Hyung Jun, Kim Kum Bae, Han Chul Ju, Park Su Cheol, Lee Dong Han
Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
J Korean Med Sci. 2015 Aug;30(8):1055-61. doi: 10.3346/jkms.2015.30.8.1055. Epub 2015 Jul 15.
This study evaluated the incidence of hepatic toxicity after stereotactic ablative radiotherapy (SABR) using 3 fractions to the liver, and identified the predictors for hepatic toxicity. We retrospectively reviewed 78 patients with primary and metastatic liver cancers, who underwent SABR using 3 fractions between 2003 and 2011. To examine the incidence of hepatic toxicity, we defined newly developed hepatic toxicity≥grade 2 according to the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 within 3 months after the end of SABR as a significant adverse event. To identify the predictors for hepatic toxicity, we analyzed several clinical and dosimetric parameters (rV5Gy-rV35Gy: normal liver volume receiving <X Gy, reverse VXGy). Hepatic toxicity≥grade 2 occurred in 10 patients (13%): grade 2 in 9 patients and grade 3 in 1 patient. On univariate analysis, baseline Child-Pugh (CP) score (5 vs. 6-8), normal liver volume, and planning target volume were the significant clinical predictors. All dosimetric parameters were significant: rV20Gy was the most significant predictor. On multivariate analysis, baseline CP score (hazard ratio, 0.026; P=0.001) was the only significant predictor. In conclusion, SABR using 3 fractions in primary and metastatic liver cancers produces low hepatic toxicity, especially in patients with a baseline CP score of 5. However, further studies are needed to minimize hepatic toxicity in patients with baseline CP scores≥6.
本研究评估了肝脏立体定向消融放疗（SABR）采用3次分割照射后的肝毒性发生率，并确定了肝毒性的预测因素。我们回顾性分析了78例原发性和转移性肝癌患者，这些患者在2003年至2011年间接受了3次分割的SABR治疗。为了研究肝毒性的发生率，我们将SABR结束后3个月内根据美国国立癌症研究所不良事件通用术语标准v4.0新出现的≥2级肝毒性定义为严重不良事件。为了确定肝毒性的预测因素，我们分析了几个临床和剂量学参数（rV5Gy-rV35Gy：接受<X Gy的正常肝脏体积，反向VXGy）。10例患者（13%）发生了≥2级肝毒性：9例为2级，1例为3级。单因素分析显示，基线Child-Pugh（CP）评分（5分与6-8分）、正常肝脏体积和计划靶体积是显著的临床预测因素。所有剂量学参数均具有显著性：rV20Gy是最显著的预测因素。多因素分析显示，基线CP评分（风险比，0.026；P=0.001）是唯一显著的预测因素。总之，原发性和转移性肝癌采用3次分割的SABR产生的肝毒性较低，尤其是基线CP评分为5分的患者。然而，需要进一步研究以将基线CP评分≥6分患者的肝毒性降至最低。
