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

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Abstract

Aims and background.

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.

Methods and study design.

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.

Results.

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, V20 Gy, V25 Gy, and V30 Gy were significantly correlated with e-CP positivity. The e-CP developed in 13 of 106 patients (12.3%) with V30 Gy of ≤28.1% and in 13 of 36 patients (36.1%) with V30 Gy >28.1% (P = 0.001).

Conclusions.

Our data demonstrate that mean liver dose, V10 Gy, V20 Gy, V25 Gy, and V30 Gy are independent dose-volumetric predictors for e-CP positivity in hepatocellular carcinoma patients treated with conformal radiation therapy. V30 Gy should be limited to less than 28.1% to minimize the risk of e-CP.

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