Risk Factors Of Radiation-induced Liver Disease After Three-dimensional Conformal Radiotherapy For Primary Liver Carcionoma

Objects:To identify the risk factors of radiation-induced liver disease(RILD)after three-dimensional radiotherapy(3DCRT)for primary liver carcinoma(PLC) and the dosimetriec threshold of RILD.Methods:Between March 2001and March 2006, 64 PLC patients who were treatedwith 3DCRT received a mean dose of 38-74 Gy with a 4-8Gy/f, 3f/w. Therelation between RILD and the possible clinical factors, such as gender,age, UICC/AJCC T stage, GTV, HBV status, PTV, TACE. Child-Pugh grade ofliver cirrhosis, BED calculated by LQ model and fraction size were analyzed. Among 64 patients who had full dose-volume histogram (DVH)data,the relation between RILD and dosimetric parameters were analyzed.Results:Tenpatients(15.6％)developed RILD. It was found thatTstage, GTV, PIV,Child-Pugh grade of liver cirrhosis and the acute hepatic toxieity proposed by colmmon toxicity criteria version 2.0(CTC2.0)were correlatedWith RILD(P=0.024,0.002,0.001,0.000,0.000, respectively).Multivariateanalysis showed that only the Child-Pugh grade of liver cirrhosis wasindependent factor(P=0.000). The mean liver dose was significantlyhigher in patients with RILD (P=0.027). In patients with Child-PughgradeA, V5(percentage of normal liver volume with radiation dose＞5Gy), V10 andV2o≤81％, 69％and 42％, mean liverdose＜28Gy, RILD was not observed,whereas in patients with Child-Pugh grade B, the possibility of developingRILD was 53.3％(8/15).Conclusions: Comprehensive consideration of T stage, GTV, PIV and Child-Pugh gradeof liver cirrhosis, especially the Child-Pugh grade of liver cirrhosis。when planning 3DCRT for PLC. may lower the incidenee of RILD.