Abstract
PurposeThis study examined the status of radiation-induced liver injury in adjuvant or palliative gastric cancer radiation therapy (RT), identified risk factors of radiation-induced liver injury in gastric cancer RT, analysed the dose-volume effects of liver injury, and developed a liver dose limitation reference for gastric cancer RT.Methods and MaterialsData for 56 post-operative gastric cancer patients and 6 locoregional recurrent gastric cancer patients treated with three-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) from Sep 2007 to Sep 2009 were analysed. Forty patients (65%) were administered concurrent chemotherapy. Pre- and post-radiation chemotherapy were given to 61 patients and 43 patients, respectively. The radiation dose was 45–50.4 Gy in 25–28 fractions. Clinical parameters, including gender, age, hepatic B virus status, concurrent chemotherapy, and the total number of chemotherapy cycles, were included in the analysis. Univariate analyses with a non-parametric rank test (Mann–Whitney test) and logistic regression test and a multivariate analysis using a logistic regression test were completed. We also analysed the correlation between RT and the changes in serum chemistry parameters [including total bilirubin, (TB), direct bilirubin (D-TB), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and serum albumin (ALB)] after RT.ResultsThe Child-Pugh grade progressed from grade A to grade B after radiotherapy in 10 patients. A total of 16 cases of classic radiation-induced liver disease (RILD) were observed, and 2 patients had both Child-Pugh grade progression and classic RILD. No cases of non-classic radiation liver injury occurred in the study population. Among the tested clinical parameters, the total number of chemotherapy cycles correlated with liver function injury. V35 and ALP levels were significant predictive factors for radiation liver injury.ConclusionsIn 3D-CRT for gastric cancer patients, radiation-induced liver injury may occur and affect the overall treatment plan. The total number of chemotherapy cycles correlated with liver function injury, and V35 and ALP are significant predictive factors for radiation-induced liver injury. Our dose limitation reference for liver protection is feasible.
Highlights
Gastric cancer is one of the most common cancers in China, and patients with lymph nodepositive disease have a 5-year survival rate as low as 15–20%
Among the tested clinical parameters, the total number of chemotherapy cycles correlated with liver function injury
The total number of chemotherapy cycles correlated with liver function injury, and V35 and alkaline phosphatase (ALP) are significant predictive factors for radiation-induced liver injury
Summary
Gastric cancer is one of the most common cancers in China, and patients with lymph nodepositive disease have a 5-year survival rate as low as 15–20%. Even node-negative patients have a 5-year survival rate of only 45–55% if the T stage is advanced (T3-T4N0) [1]. Three-dimensional radiation therapy (3D-RT) is a common treatment method for gastric adenocarcinoma [2]. The radiation volume for gastric cancer is very large, including the clinical target volume (CTV) that is adjacent to the liver and contains the tumour bed, anastomosis, gastric remnant (pT3-T4), and regional draining lymph nodes. The liver occupies a large proportion of the upper abdominal cavity, and hepatic hilar lymph nodes need to be contained in the CTV for the majority of patients. It is difficult to deliver an effective prescription dose to the target while keeping the exposure of normal tissue (e.g., liver and kidney) to a low dose
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