Prognostic factor of primary liver cancer treated by hypofractionated three-dimensional conformal radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the toxicity and efficacy of primary liver cancer (PLC) treated by hypofractionated three-dimensional conformal radiotherapy (3DCRT) and investigate the prognostic factors.</p><p><b>METHODS</b>Between April 1999 and August 2003, 128 PLC patients received hypofractionated 3DCRT. According to UICC/AJCC staging system, there were 83 T3 patients, 45 T4, with none of them having lymph node metastasis. The mean value of gross tumor volume (GTV) was (458.92 +/- 429.8) cm(3) (6.2-2097 cm(3)). Thirty-four patients had portal vein tumor thrombosis (PVTT). 108 patients had Child-Pugh Grade A liver cirrhosis and 20 Child-Pugh Grade B liver cirrhosis. All patients received a total dose of (53.6 +/- 6.6) Gy/4-8 Gy per fraction/3 fractions per week. Forty-eight of these patients received 3DCRT combined with transarterial chemoembolization (TACE).</p><p><b>RESULTS</b>Seven patients died within 3 months after the treatment were dismissed from the series. The response rate (CR + PR) was 55% (67/121). The overall 1-, 2-, and 3-year survival rate was 65.0%, 43.3%, and 33.1%, respectively. T stage (P = 0.001), GTV (P = 0.0001), PVTT (P = 0.0001) and Child-Pugh Grade (P = 0.0001) had significant impact on the overall survival. However, only GTV and Child-Pugh Grade were independent significant prognostic factors by Cox-regression analysis, (P = 0.044 and P = 0.015).</p><p><b>CONCLUSION</b>T stage, GTV, PVTT and Child-Pugh Grade have significant impact on the overall survival in primary liver cancer patients treated by three-dimensional conformal radiotherapy. But only GTV and Child-Pugh Grade are independent prognostic factors.</p>

Lyman NTCP model analysis of radiaton-induced liver disease in hypofractionated conformal radiotherapy for primary liver carcinoma / 中华放射肿瘤学杂志

Objective To-identify the factors associated with radiation-induced liver disease (RILD) and to describe the probability of RILD using the Lyman normal tissue complication(NTCP) model for primary liver carcinoma(PLC) treated with hypofractionated conformal therapy (CRT).Methods A total of 109 PLC patients treated with hypofractionated CRT were prospectively followed according to the Child-Pugh classification for liver cirrhosis,93 patients in class A and 16 in class B.The mean dose of radi- ation to the isocenter was (53.5?5.5) Gy,fractions of (4.8?0.5) Gy,with interfraction interval of 48 hours and irradiation 3 times per week.Maximal likelihood analysis yielded the best estimates of parameters of the Lyman NTCP model for all patients;Child-Pugh A and Child-Pugh B patients,respectively.Results Of all the patients,17 developed RILD (17/109),8 in Child-Pugh A(8/93 ) and 9 in Child-Pugh B(9/ 16).By multivariate analysis,only the Child-Pugh Grade of liver cirrhosis was the independent factor (P= 0.000) associated with the developing of RILD.The best estimates of the NTCP parameters for all 109 pa- tients were n=1.1,m=0.35 and TD_(50) (1)=38.5 Gy.The n,m,TD_(50) (1) estimated from patients with Child-Pugh A was 1.1,0.28,40.5 Gy,respectively,compared with 0.7,0.43,23 Gy respectively,for patients with Child-Pugh B.Conclusions Primary liver cancer patients who possess Child-Pugh B cirrho- sis would present a significantly greater susceptibility to RILD after hypofractionated CRT than patients with Child-Pugh A cirrhosis.The predominant risk factor for developing RILD is the severity of hepatic cirrhosis in the liver of PLC patients.