Abstract
This study aimed to evaluate the dynamic computed tomographic (CT) appearance of focal radiation injury to cirrhotic liver tissue around the tumor following stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Seventy-seven patients with 92 HCCs were observed for >6 months. Sixty-four and 13 patients belonged to Child–Pugh class A and B, respectively. The median SBRT dose was 48 Gy/4fr. Dynamic CT scans were performed in non–enhanced, arterial, portal, and venous phases. The median follow-up period was 18 months. Dynamic CT appearances were classified into 3 types: type 1, hyperdensity in all enhanced phases; type 2, hypodensity in arterial and portal phases; type 3, isodensity in all enhanced phases. Half of the type 2 or 3 appearances significantly changed to type 1, particularly in patients belonging to Child–Pugh class A. After 3–6 months, Child–Pugh class B was a significant factor in type 3 patients. Thus, dynamic CT appearances were classified into 3 patterns and significantly changed over time into the enhancement group (type 1) in most patients belonging to Child–Pugh class A. Child–Pugh class B was a significant factor in the non–enhancement group (type 3).
Highlights
Radiation-induced liver disease (RILD) is an adverse effect pathologically characterized as a veno-occlusive disease (VOD) [1] that often exhibits severe or fatal complications followingPLOS ONE | DOI:10.1371/journal.pone.0125231 June 11, 2015computed tomography (CT) Appearance of Liver Radiation Injury after stereotactic body radiation therapy (SBRT) conventional radiation therapy for large hepatic volumes
Recent advances in imaging and radiation techniques provide high radiation doses to conform to focal hepatocellular carcinoma (HCC), and several studies have described good treatment results for stereotactic body radiation therapy (SBRT) or particle therapy without severe clinical signs of RILD [2,3,4,5]
We have observed that the CT appearance of tumor response following SBRT differs from that following conventional radiotherapy [9]; we focused on normal or cirrhotic liver injury in the present study
Summary
Radiation-induced liver disease (RILD) is an adverse effect pathologically characterized as a veno-occlusive disease (VOD) [1] that often exhibits severe or fatal complications followingPLOS ONE | DOI:10.1371/journal.pone.0125231 June 11, 2015CT Appearance of Liver Radiation Injury after SBRT conventional radiation therapy for large hepatic volumes. The CT appearance of focal radiation injury reflects the irradiated area of the normal liver, it is important to correctly investigate the imaging finding following SBRT because HCC patients may require additional multiple therapies in future. The CT appearance of radiation injury has been reported, and we have often observed that injury appearance following SBRT changed with time and differs from that following conventional radiotherapy [6,7,8]. Few studies have investigated the relationship between the change in CT appearance over time following SBRT and related factors or adverse effects. We have observed that the CT appearance of tumor response following SBRT differs from that following conventional radiotherapy [9]; we focused on normal or cirrhotic liver injury in the present study
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