Michael Velec1, Carol R Haddad2, Tim Craig3, Lisa Wang4, Patricia Lindsay3, James Brierley3, Anthony Brade3, Jolie Ringash3, Rebecca Wong3, John Kim3, Laura A Dawson5. 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. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. 4. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 5. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. Electronic address: Laura.Dawson@rmp.uhn.on.ca.
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 × 109/L vs 150 × 109/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.
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 × 109/L vs 150 × 109/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.
Authors: Jennifer Pursley; Issam El Naqa; Nina N Sanford; Bridget Noe; Jennifer Y Wo; Christine E Eyler; Matthew Hwang; Kristy K Brock; Beow Y Yeap; John A Wolfgang; Theodore S Hong; Clemens Grassberger Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-27 Impact factor: 7.038
Authors: Eleni Gkika; Dominik Bettinger; Leo Krafft; Michael Schultheiss; Hannes Philipp Neeff; Lars Maruschke; Michaela Schulenburg; Sonja Adebahr; Simon Kirste; Ursula Nestle; Robert Thimme; Anca-Ligia Grosu; Thomas Baptist Brunner Journal: Strahlenther Onkol Date: 2018-01-10 Impact factor: 3.621
Authors: Luca Boldrini; Angela Romano; Silvia Mariani; Davide Cusumano; Francesco Catucci; Lorenzo Placidi; Gian Carlo Mattiucci; Giuditta Chiloiro; Francesco Cellini; Maria Antonietta Gambacorta; Luca Indovina; Vincenzo Valentini Journal: J Cancer Res Clin Oncol Date: 2021-01-04 Impact factor: 4.553
Authors: W C Jackson; K Suresh; C Maurino; M Feng; K C Cuneo; R K Ten Haken; T S Lawrence; M J Schipper; D Owen Journal: Radiother Oncol Date: 2019-08-17 Impact factor: 6.280
Authors: Ashwathy Susan Mathew; Eshetu G Atenafu; Dawn Owen; Chris Maurino; Anthony Brade; James Brierley; Robert Dinniwell; John Kim; Charles Cho; Jolie Ringash; Rebecca Wong; Kyle Cuneo; Mary Feng; Theodore S Lawrence; Laura A Dawson Journal: Eur J Cancer Date: 2020-05-24 Impact factor: 9.162
Authors: Krithika Suresh; Dawn Owen; Latifa Bazzi; William Jackson; Randall K Ten Haken; Kyle Cuneo; Mary Feng; Theodore S Lawrence; Matthew J Schipper Journal: Int J Radiat Oncol Biol Phys Date: 2017-09-22 Impact factor: 7.038
Authors: Issam El Naqa; Adam Johansson; Dawn Owen; Kyle Cuneo; Yue Cao; Martha Matuszak; Latifa Bazzi; Theodore S Lawrence; Randall K Ten Haken Journal: Int J Radiat Oncol Biol Phys Date: 2018-02-01 Impact factor: 7.038