Impact of Fractionated Stereotactic Body Radiotherapy on Liver Function in Patients with Hepatitis B Virus–related Hepatocellular Carcinoma: Clinical and Dosimetric Analysis
CKK Choi, FAS Lee, TC Lam, FCS Wong, VY Wong, C Lui, WK Sze, SY Tung
Hong Kong J Radiol 2013;16:94-9
DOI: 10.12809/hkjr1312147
Objective: To investigate the impact of fractionated stereotactic body radiotherapy (SBRT) on liver function and identify any dosimetric parameters that may predict deterioration of liver function in patients with hepatitis B (HBV)–related hepatocellular carcinoma (HCC).
Methods:Thirty-six eligible patients with HBV-related HCC who were treated with fractionated SBRT between January 2008 and December 2010 were assessed. The treatment prescription ranged from 20 to 40 Gy (median, 32 Gy) in 5 to 10 fractions over 1 to 2 weeks. All the patients received pre-emptive antiviral therapy. The median gross tumour volume was 509 cm3 (range, 2-3088 cm3). Four liver toxicity endpoints were assessed: (1) rate of HBV reactivation; (2) rate of chronic hepatitis B exacerbation; (3) rate of radiotherapy-induced liver disease; and (4) rate of deterioration in Child-Pugh class. Clinical and dosimetric parameters were evaluated to identify the significant predictors of liver toxicity.
Results:No patient developed HBV reactivation, chronic hepatitis B exacerbation, or radiotherapy-induced liver disease within 3 months after SBRT. Four (11%) experienced Child-Pugh class deterioration. On univariate analysis, no clinical and dosimetric parameters were identified as predictors of Child-Pugh class deterioration.
Conclusion:SBRT with individualised dosing of up to 40 Gy in 10 fractions can be delivered safely to patients with large unresectable HBV-related HCC in palliative setting. Pre-emptive antiviral therapy is probably mandatory to prevent HBV-related complications in this setting.
中文摘要
乙型肝炎病毒相關性肝細胞癌患者中分次立體定向放射治療對肝功能的 影響：臨床和劑量學分析
蔡國強、李安誠、林泰忠、黃志成、王懿明、雷鳴明、施永健、董煜
目的：探討分次立體定向放射治療（SBRT）對肝功能的影響，並在乙型肝炎病毒（HBV）相關性肝 細胞癌患者中，找出可能預測肝功能惡化的劑量參數。
方法：篩選並評估36名在2008年1月至2010年12月期間進行分次SBRT的HBV相關性肝細胞癌患者。 治療方案為患者於一至兩週內接受5至10次放療，總劑量從20 Gy至40 Gy不等（中位數：32 Gy）。所有患者在放療前先接受抗病毒治療。腫瘤大致體積的中位數為509 cm3（介乎2-3088 cm3）。分別 有四項肝毒性評估點：（1）HBV再活率；（2）慢性乙型肝炎的惡化率；（3）放射性肝損傷的發病 率；和（4）Child-Pugh分級的惡化率。然後評估臨床和劑量參數以確定肝毒性的有效預測因子。
結果：進行SBRT後三個月，無患者出現HBV再激活、慢性乙型肝炎惡化或因放療導致的肝病。4名 患者（11.1%）的Child-Pugh分級出現惡化。單因素分析顯示並無臨床及劑量參數可以預測Child-Pugh 分級惡化。
結論：：對於因瘤體大不能手術切除，而採取姑息治療的HBV相關性肝癌患者來說，分10次接受總劑 量達40 Gy的個體化SBRT是安全的。患者放療前應先接受強制性的抗病毒治療，以防止HBV相關的 併發症。