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Open Access Research

Dosimetric parameter predicting the deterioration of hepatic function after helical tomotherapy in patients with unresectable locally advanced hepatocellular carcinoma

Seok Hyun Son1, Chul Seung Kay1, Jin Ho Song1, Sea-Won Lee1, Byung Ock Choi1, Young Nam Kang1, Jeong Won Jang2, Seung Kew Yoon2 and Hong Seok Jang1*

Author Affiliations

1 Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea

2 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

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Radiation Oncology 2013, 8:11  doi:10.1186/1748-717X-8-11

Published: 9 January 2013

Abstract

Background

The purpose of this study was to identify parameters capable of predicting the deterioration of hepatic function after helical tomotherapy in patients with unresectable locally advanced hepatocellular carcinoma.

Methods

Between March 2006 and February 2012, 72 patients were eligible for this study. All patients received hypofractionated radiotherapy using the TomoTherapy Hi-Art (TomoTherapy, Madison, WI, USA) at Seoul St. Mary's Hospital and Incheon St. Mary's Hospital, the Catholic University of Korea. The radiation dose was a median 50 Gy (range: 40–50 Gy) in 10 fractions to 95% of the planning target volume. Radiation-induced hepatic toxicity was defined as an increase of at least 2 points in the Child-Pugh (CP) score within 3 months after completion of helical tomotherapy.

Results

An increase of at least 2 points in the CP score occurred in 32 of the 72 patients (44.4%). Multivariate logistic regression analysis revealed that pretreatment CP class and V15Gy were significant parameters associated with an increase in CP score (p = 0.009 and p < 0.001, respectively). The area under receiver operating characteristic curve was 0.863 for V15Gy (p < 0.001). For V15Gy, with a cutoff value of 43.2%, the accuracy was 0.806 (58/72) with a sensitivity of 0.938 and a specificity of 0.725.

Conclusions

An increase of at least 2 points in the CP score is a radiation dose-limiting factor, and the non-target normal liver receiving a dose more than 15 Gy (V15Gy) should be <43.2% to reduce the risk of the deterioration of hepatic function.

Keywords:
Hepatocellular carcinoma (HCC); Helical tomotherapy; Radiation-induced hepatic toxicity (RIHT); Child-Pugh score (CP score); Dosimetric parameter; The deterioration of hepatic function