Mukai Yuki, Matsuyama Ryusei, Koike Izumi, Kumamoto Takafumi, Kaizu Hisashi, Homma Yuki, Takano Shoko, Sawada Yu, Sugiura Madoka, Yabushita Yasuhiro, Ito Eiko, Sato Mizuki, Endo Itaru, Hata Masaharu
Department of Radiation Oncology.
Departments of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Japan.
Medicine (Baltimore). 2019 Aug;98(31):e16673. doi: 10.1097/MD.0000000000016673.
The aim of this study was to analyze dose-volume histogram (DVH) of the remnant liver for postoperative cholangiocarcinoma (CCA) patients, to find toxicity rates, and to confirm efficacy of postoperative radiation therapy (RT).Thirty-two postoperative CCA patients received partial liver resection and postoperative RT with curative intent. The "liver reduction rate" was calculated by contouring liver volume at computed tomography (CT) just before the surgery and at CT for planning the RT. To evaluate late toxicity, the radiation-induced hepatic toxicity (RIHT) was determined by the common terminology criteria for adverse events toxicity grade of bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, and albumin, and was defined from 3 months after RT until liver metastasis was revealed. The radiation-induced liver disease (RILD) was also evaluated.Tumor stages were distributed as follows: I: 1, II: 8, IIIA: 1, IIIB: 6, IIIC: 14, IVA: 2. Median prescribed total dose was 50 Gy. Median follow-up time was 27 months. Two-year overall survival (OS): 72.4%, disease-free survival: 47.7%, local control: 65.3%, and the median survival time was 40 months. The median "liver reduction rate" was 21%. The OS had statistically significant difference in nodal status (P = .032) and "liver reduction rate" >30% (P = .016). In the association between the ≥grade 2 RIHT and DVH, there were significantly differences in V30 and V40 (P = .041, P = .034), respectively. The grade ≥2 RIHT rates differ also significantly by sex (P = .008). Two patients (6.2%) were suspected of RILD.We suggest that RT for remnant liver should be considered the liver V30, V40 to prevent radiation-induced liver dysfunction.
本研究旨在分析胆管癌（CCA）术后患者残余肝脏的剂量体积直方图（DVH），以确定毒性发生率，并证实术后放射治疗（RT）的疗效。32例CCA术后患者接受了部分肝切除及根治性术后RT。“肝脏缩小率”通过手术前计算机断层扫描（CT）及RT计划CT时勾勒肝脏体积来计算。为评估晚期毒性，根据胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、碱性磷酸酶和白蛋白的不良事件毒性分级通用术语标准确定放射性肝毒性（RIHT），并定义为RT后3个月直至出现肝转移。还对放射性肝病（RILD）进行了评估。肿瘤分期分布如下：I期：1例，II期：8例，IIIA期：1例，IIIB期：6例，IIIC期：14例，IVA期：2例。中位处方总剂量为50 Gy。中位随访时间为27个月。两年总生存率（OS）：72.4%，无病生存率：47.7%，局部控制率：65.3%，中位生存时间为40个月。中位“肝脏缩小率”为21%。OS在淋巴结状态（P = 0.032）和“肝脏缩小率”>30%（P = 0.016）方面有统计学显著差异。在≥2级RIHT与DVH的关联中，V30和V40分别有显著差异（P = 0.041，P = 0.034）。≥2级RIHT发生率在性别上也有显著差异（P = 0.008）。2例患者（6.2%）疑似发生RILD。我们建议，对于残余肝脏的RT，应考虑肝脏V30、V40，以预防放射性肝功能障碍。
