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Title: Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Abstract

Purpose: To identify risk factors associated with a decline in liver function after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma. Methods and Materials: Data were analyzed from patients with hepatocellular carcinoma treated on clinical trials of 6-fraction SBRT. Liver toxicity was defined as an increase in Child-Pugh (CP) score ≥2 three months after SBRT. Clinical factors, SBRT details, and liver dose-volume histogram (DVH) parameters were tested for association with toxicity using logistic regression. CP class B patients were analyzed separately. Results: Among CP class A patients, 101 were evaluable, with a baseline score of A5 (72%) or A6 (28%). Fifty-three percent had portal vein thrombus. The median liver volume was 1286 cc (range, 766-3967 cc), and the median prescribed dose was 36 Gy (range, 27-54 Gy). Toxicity was seen in 26 patients (26%). Thrombus, baseline CP of A6, and lower platelet count were associated with toxicity on univariate analysis, as were several liver DVH-based parameters. Absolute and spared liver volumes were not significant. On multivariate analysis for CP class A patients, significant associations were found for baseline CP score of A6 (odds ratio [OR], 4.85), lower platelet count (OR, 0.90; median, 108 × 10{sup 9}/L vs 150 × 10{sup 9}/L), higher mean liver dose (OR, 1.33; median,more » 16.9 Gy vs 14.7 Gy), and higher dose to 800 cc of liver (OR, 1.11; median, 14.3 Gy vs 6.0 Gy). With 13 CP-B7 patients included or when dose to 800 cc of liver was replaced with other DVH parameters (eg, dose to 700 or 900 cc of liver) in the multivariate analysis, effective volume and portal vein thrombus were associated with an increased risk. Conclusions: Baseline CP scores and higher liver doses (eg, mean dose, effective volume, doses to 700-900 cc) were strongly associated with liver function decline 3 months after SBRT. A lower baseline platelet count and portal vein thrombus were also associated with an increased risk.« less

Authors:
 [1];  [2];  [1];  [3];  [4]; ; ; ; ; ;  [1];  [3];  [1];  [3]
  1. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada)
  2. Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales (Australia)
  3. (Canada)
  4. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada)
Publication Date:
OSTI Identifier:
22649883
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 5; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CLINICAL TRIALS; GY RANGE 01-10; GY RANGE 10-100; HEPATOMAS; LIVER; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION DOSES; RADIATION HAZARDS; RADIOTHERAPY; TOXICITY; VEINS

Citation Formats

Velec, Michael, Haddad, Carol R., Craig, Tim, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Wang, Lisa, Lindsay, Patricia, Brierley, James, Brade, Anthony, Ringash, Jolie, Wong, Rebecca, Kim, John, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Dawson, Laura A., E-mail: Laura.Dawson@rmp.uhn.on.ca, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.01.221.
Velec, Michael, Haddad, Carol R., Craig, Tim, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Wang, Lisa, Lindsay, Patricia, Brierley, James, Brade, Anthony, Ringash, Jolie, Wong, Rebecca, Kim, John, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Dawson, Laura A., E-mail: Laura.Dawson@rmp.uhn.on.ca, & Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma. United States. doi:10.1016/J.IJROBP.2017.01.221.
Velec, Michael, Haddad, Carol R., Craig, Tim, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Wang, Lisa, Lindsay, Patricia, Brierley, James, Brade, Anthony, Ringash, Jolie, Wong, Rebecca, Kim, John, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Dawson, Laura A., E-mail: Laura.Dawson@rmp.uhn.on.ca, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario. Sat . "Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma". United States. doi:10.1016/J.IJROBP.2017.01.221.
@article{osti_22649883,
title = {Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma},
author = {Velec, Michael and Haddad, Carol R. and Craig, Tim and Department of Radiation Oncology, University of Toronto, Toronto, Ontario and Wang, Lisa and Lindsay, Patricia and Brierley, James and Brade, Anthony and Ringash, Jolie and Wong, Rebecca and Kim, John and Department of Radiation Oncology, University of Toronto, Toronto, Ontario and Dawson, Laura A., E-mail: Laura.Dawson@rmp.uhn.on.ca and Department of Radiation Oncology, University of Toronto, Toronto, Ontario},
abstractNote = {Purpose: To identify risk factors associated with a decline in liver function after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma. Methods and Materials: Data were analyzed from patients with hepatocellular carcinoma treated on clinical trials of 6-fraction SBRT. Liver toxicity was defined as an increase in Child-Pugh (CP) score ≥2 three months after SBRT. Clinical factors, SBRT details, and liver dose-volume histogram (DVH) parameters were tested for association with toxicity using logistic regression. CP class B patients were analyzed separately. Results: Among CP class A patients, 101 were evaluable, with a baseline score of A5 (72%) or A6 (28%). Fifty-three percent had portal vein thrombus. The median liver volume was 1286 cc (range, 766-3967 cc), and the median prescribed dose was 36 Gy (range, 27-54 Gy). Toxicity was seen in 26 patients (26%). Thrombus, baseline CP of A6, and lower platelet count were associated with toxicity on univariate analysis, as were several liver DVH-based parameters. Absolute and spared liver volumes were not significant. On multivariate analysis for CP class A patients, significant associations were found for baseline CP score of A6 (odds ratio [OR], 4.85), lower platelet count (OR, 0.90; median, 108 × 10{sup 9}/L vs 150 × 10{sup 9}/L), higher mean liver dose (OR, 1.33; median, 16.9 Gy vs 14.7 Gy), and higher dose to 800 cc of liver (OR, 1.11; median, 14.3 Gy vs 6.0 Gy). With 13 CP-B7 patients included or when dose to 800 cc of liver was replaced with other DVH parameters (eg, dose to 700 or 900 cc of liver) in the multivariate analysis, effective volume and portal vein thrombus were associated with an increased risk. Conclusions: Baseline CP scores and higher liver doses (eg, mean dose, effective volume, doses to 700-900 cc) were strongly associated with liver function decline 3 months after SBRT. A lower baseline platelet count and portal vein thrombus were also associated with an increased risk.},
doi = {10.1016/J.IJROBP.2017.01.221},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 97,
place = {United States},
year = {Sat Apr 01 00:00:00 EDT 2017},
month = {Sat Apr 01 00:00:00 EDT 2017}
}