The Use of Normal Tissue Complication Probability to Predict Radiation Hepatitis

간암의 정상조직손상확률을 이용한 방사선간염의 발생여부 예측가능성에 관한 연구

  • Keum Ki Chang (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Seong Jinsil (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Suh Chang Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee Sang-wook (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Chung Eun Ji (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Shin Hyun Soo (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim Gwi Eon (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • 금기창 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 성진실 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 서창옥 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 이상욱 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 정은지 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 신현수 (연세대학교 의과대학 방사선종양학교실, 연세암센터) ;
  • 김귀언 (연세대학교 의과대학 방사선종양학교실, 연세암센터)
  • Published : 2000.12.01

Abstract

Purpose : Though It has been known that the to tolerance of the liver to external beam irradiation depends on the irradiated volume and dose, few data exist which Quantify this dependence. However, recently, with the development of three dimensional (3-D) treatment planning, have the tools to Quantify the relationships between dose, volume, and normal tissue complications become available. The objective of this study is to investigate the relationships between normal tissue complication probabili쇼 (WCP) and the risk of radiation hepatitis for patients who received variant dose partial liver irradiation. Materials and Methods : From March 1992 to December 1994, 10 patients with hepatoma and 10 patients with bile duct cancer were included in this study. Eighteen patients had normal hepatic function, but 2 patients (prothrombin time 73$\%$, 68$\%$) had mild liver cirrhosis before irradiation. Radiation therapy was delivered with 10MV linear accelerator, 180$\~$200 cGy fraction per day. The total dose ranged from 3,960 cGy to 6,000 cGy (median dose 5,040 cGy). The normal tissue complication probability was calculated by using Lyman's model. Radiation hepatitis was defined as the development of anicteric elevation of alkaline phosphatase of at least two fold and non-malignant ascites in the absence of documented progressive. Results: The calculated NTCP ranged from 0.001 to 0.840 (median 0.05). Three of the 20 patients developed radiation hepatitis. The NTCP of the patients with radiation hepatitis were 0.390, 0.528, 0.844(median : 0.58$\pm$0.23), but that of the patients without radiation hepatitis ranged fro 0.001 to 0.308 (median .0.09$\pm$0.09). When the NTCP was calculated by using the volume factor of 0.32, a radiation hepatitis was observed only in patients with the NTCP value more than 0.39. By contrast, clinical results of evolving radiation hepatitis were not well correlated with NTCP value calculated when the volume factor of 0.69 was applied. On the basis of these observations, the volume factor of 0.32 was more correlated to predict a radiation hepatitis. Conclusion : The risk of radiation hepatitis was increased above the cut-off value. Therefore the NTCP seems to be used for predicting the radiation hepatitis.