Development and validation of a nomogram for radiation-induced hepatic toxicity after intensity modulated radiotherapy for hepatocellular carcinoma: a retrospective study.
Jpn J Clin Oncol
; 54(6): 699-707, 2024 Jun 01.
Article
in En
| MEDLINE
| ID: mdl-38376811
ABSTRACT
OBJECTIVE:
This study aimed to construct a nomogram to predict radiation-induced hepatic toxicity in patients with hepatocellular carcinoma treated with intensity-modulated radiotherapy.METHODS:
This study reviewed the clinical characteristics and dose-volume parameters of 196 patients with hepatocellular carcinoma. Radiation-induced hepatic toxicity was defined as progression of the Child-Pugh score caused by intensity-modulated radiotherapy. Factors relevant to radiation-induced hepatic toxicity were selected using receiver operating characteristic and univariate logistic analysis. A risk assessment model was developed, and its discrimination was validated.RESULTS:
Eighty-eight (44.90%) and 28 (14.29%) patients had radiation-induced hepatic toxicity ≥ 1 (Child-Pugh ≥ 1) and radiation-induced hepatic toxicity ≥ 2 (Child-Pugh ≥ 2). Pre-treatment Child-Pugh, body mass index and dose-volume parameters were correlated with radiation-induced hepatic toxicity ≥ 1 using univariate logistic analysis. V15 had the best predictive effectiveness among the dose-volume parameters in both the training (area under the curve 0.763, 95% confidence interval 0.683-0.842, P < 0.001) and validation cohorts (area under the curve 0.759, 95% confidence interval 0.635-0.883, P < 0.001). The area under the curve values of the model that was constructed by pre-treatment Child-Pugh, body mass index and V15 for radiation-induced hepatic toxicity ≥1 were 0.799 (95% confidence interval 0.719-0.878, P < 0.001) and 0.775 (95% confidence interval 0.657-0.894, P < 0.001) in the training and validation cohorts, respectively. Patients with a body mass index ≤ 20.425, Barcelona clinic liver cancer = C, Hepatitis B Virus-positive, Eastern Cooperative Oncology Group = 1-2 and hepatic fibrosis require lower V15 dose limits.CONCLUSIONS:
Risk assessment model constructed from Pre-treatment Child-Pugh, V15 and body mass index can guide individualized patient selection of toxicity minimization strategies.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Radiation Injuries
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Carcinoma, Hepatocellular
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Nomograms
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Radiotherapy, Intensity-Modulated
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Liver Neoplasms
Limits:
Adult
/
Aged
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Aged80
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
Jpn J Clin Oncol
Year:
2024
Document type:
Article
Affiliation country:
China