The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical significance of radiation-induced liver disease after stereotactic body radiation therapy for hepatocellular carcinoma

  • Jun, Baek Gyu (Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kim, Young Don (Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Cheon, Gab Jin (Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kim, Eun Seog (Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital) ;
  • Jwa, Eunjin (Department of Radiation Oncology, Soonchunhyang University Cheonan Hospital) ;
  • Kim, Sang Gyune (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Young Seok (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Boo Sung (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jeong, Soung Won (Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Jang, Jae Young (Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Lee, Sae Hwan (Department of Internal Medicine, Soonchunhyang University Cheonan Hospital) ;
  • Kim, Hong Soo (Department of Internal Medicine, Soonchunhyang University Cheonan Hospital)
  • Received : 2016.12.12
  • Accepted : 2017.03.17
  • Published : 2018.11.01
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Abstract

Background/Aims: The aim of this study was to investigate parameters that predict radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to identify the clinical significance of RILD. Methods: We retrospectively reviewed the medical records of 117 HCC patients who were treated by SBRT from March 2011 to February 2015. RILD was defined as elevated liver transaminases more than five times the upper normal limit or a worsening of Child-Pugh (CP) score by 2 within 3 months after SBRT. All patients were assessed at 1 month and every 3 months after SBRT. Results: Median follow-up was 22.5 months (range, 3 to 56) after SBRT. RILD was developed in 29 of the 117 patients (24.7%). On univariate analysis, significant predictive factors of RILD were pretreatment CP score (p < 0.001) and normal liver volume (p = 0.002). Multivariate analysis showed that CP score was a significant predictor of RILD (p < 0.001). The incidence of RILD increased above a CP score of 6 remarkably. The rate of recovery from RILD decreased significantly above a CP score of 8. Survival analysis showed that CP score was an independent prognostic factor of overall survival (p = 0.001). Conclusions: CP score is a significant factor to predict RILD in patients with chronic liver disease. RILD can be tolerated by patients with a CP score ${\leq}7$. However, careful monitoring of liver function is needed for patients with a CP score 7 after SBRT.

Keywords

References

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