Tobias R Chapman1, Stephen R Bowen2, Stephanie K Schaub3, Rosanna H Yeung3, Sharon W Kwan4, James O Park5, Lei Yu6, William P Harris7, Guy E Johnson8, Iris W Liou5, Matthew J Nyflot2, Smith Apisarnthanarax9. 1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 2. Department of Radiation Oncology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington. 3. Department of Radiation Oncology, University of Washington, Seattle, Washington. 4. Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington. 5. Department of Surgery, University of Washington, Seattle, Washington. 6. Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington. 7. Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington. 8. Department of Radiology, University of Washington, Seattle, Washington. 9. Department of Radiation Oncology, University of Washington, Seattle, Washington. Electronic address: apisarn@uw.edu.
Abstract
BACKGROUND: Our purpose was to define the most clinically relevant "nonclassic" radiation-induced liver disease (RILD) endpoints in cirrhotic patients receiving stereotactic body radiation therapy or proton beam therapy for primary liver cancer. METHODS AND MATERIALS: We retrospectively collected pretreatment, detailed toxicity (≤6 months posttreatment), and outcomes data from 48 patients. Deaths were examined for association with RILD. Univariate and multivariate Cox models defined significant predictors of overall survival (OS)/RILD-specific survival (RILD-SS). RESULTS: With median follow-up of 13 months, 23 patients (48%) had an increase in Child-Pugh (CP) score (≥2, 25%) and 3 (6%) had ≥G3 transaminase elevation. Of 18 deaths, 6 were potentially ascribed to RILD. Univariate analysis showed that CP score increases of ≥1 and ≥2 and CP class change predicted OS, as did ≥G3 aspartate transaminase (AST) elevation and ≥1 Common Terminology Criteria for Adverse Events (CTCAE) AST toxicity grade change. On multivariate analysis, CP score increase of ≥2 and ≥1 CTCAE AST toxicity grade change were the strongest independent nonclassic RILD predictors of OS. For RILD-SS, CP score increases of ≥2, ≥grade 3 CTCAE alanine transaminase, and ≥grade 2 bilirubin elevations were predictive. CONCLUSIONS: Increased CP score ≥2 strongly predicts for both OS and RILD-SS and should be reported in future studies along with transaminase elevations, which are also predictive of outcomes.
BACKGROUND: Our purpose was to define the most clinically relevant "nonclassic" radiation-induced liver disease (RILD) endpoints in cirrhotic patients receiving stereotactic body radiation therapy or proton beam therapy for primary liver cancer. METHODS AND MATERIALS: We retrospectively collected pretreatment, detailed toxicity (≤6 months posttreatment), and outcomes data from 48 patients. Deaths were examined for association with RILD. Univariate and multivariate Cox models defined significant predictors of overall survival (OS)/RILD-specific survival (RILD-SS). RESULTS: With median follow-up of 13 months, 23 patients (48%) had an increase in Child-Pugh (CP) score (≥2, 25%) and 3 (6%) had ≥G3 transaminase elevation. Of 18 deaths, 6 were potentially ascribed to RILD. Univariate analysis showed that CP score increases of ≥1 and ≥2 and CP class change predicted OS, as did ≥G3 aspartate transaminase (AST) elevation and ≥1 Common Terminology Criteria for Adverse Events (CTCAE) ASTtoxicity grade change. On multivariate analysis, CP score increase of ≥2 and ≥1 CTCAE ASTtoxicity grade change were the strongest independent nonclassic RILD predictors of OS. For RILD-SS, CP score increases of ≥2, ≥grade 3 CTCAE alanine transaminase, and ≥grade 2 bilirubin elevations were predictive. CONCLUSIONS: Increased CP score ≥2 strongly predicts for both OS and RILD-SS and should be reported in future studies along with transaminase elevations, which are also predictive of outcomes.
Authors: Peter Lee; Yunsheng Ma; Isabel Zacharias; Adel Bozorgzadeh; Sean Wilson; Kim Foley; Paul Rava; Mark Masciocchi; Linda Ding; Jacob Bledsoe; Thomas J Fitzgerald; Shirin Sioshansi Journal: Adv Radiat Oncol Date: 2020-04-09
Authors: Stephanie K Schaub; Pehr E Hartvigson; Michael I Lock; Morten Høyer; Thomas B Brunner; Higinia R Cardenes; Laura A Dawson; Edward Y Kim; Nina A Mayr; Simon S Lo; Smith Apisarnthanarax Journal: Technol Cancer Res Treat Date: 2018-01-01
Authors: Trey C Mullikin; Kay M Pepin; Jaden E Evans; Sudhakar K Venkatesh; Richard L Ehman; Kenneth W Merrell; Michael G Haddock; William S Harmsen; Michael G Herman; Christopher L Hallemeier Journal: Adv Radiat Oncol Date: 2021-09-09