Predictive factors for Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy: dose-volume histogram analysis.

Abstract

We designed the study to identify the clinical and dose-volumetric parameters associated with the risk of Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy. All 161 hepatocellular carcinoma patients in the study underwent 4D-computed tomography simulation, and a dose-volume histogram was generated after radiotherapy planning. Patients who had an elevated Child-Pugh (e-CP) score of 2 or more without progressive disease within 3 months were defined as e-CP positive. Twenty-six of 142 patients without progressive disease were e-CP positive. Pretreatment Child-Pugh class, further treatment within 30 days of radiotherapy, lymph node metastasis, mean liver dose, V(20 Gy), V(25 Gy), and V(30 Gy) were significantly correlated with e-CP positivity. The e-CP developed in 13 of 106 patients (12.3%) with V(30 Gy) of ≤28.1% and in 13 of 36 patients (36.1%) with V(30 Gy) >28.1% (P = 0.001). Our data demonstrate that mean liver dose, V(10 Gy), V(20 Gy), V(25 Gy), and V(30 Gy) are independent dose-volumetric predictors for e-CP positivity in hepatocellular carcinoma patients treated with conformal radiation therapy. V(30 Gy) should be limited to less than 28.1% to minimize the risk of e-CP.