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Radiation-induced Liver Injury after 3D-conformal Radiotherapy for Hepatocellular Carcinoma: Quantitative Assessment Using Gd-EOB-DTPA-enhanced MRI.

Abstract
Focal liver reaction (FLR) appears in the hepatobiliary-phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) following radiotherapy (RT). We investigated the threshold dose (TD) for FLR development in 13 patients with hepatocellular carcinoma (HCC) who underwent three-dimensional conformal radiotherapy (3D-CRT) with 45 Gy in 15 fractions. FLR volumes (FLRVs) were calculated based on planning CT images by referring to fused hepatobiliary- phase images. We also calculated the TD and the irradiated volumes (IVs) of the liver parenchyma at a given dose of every 5 Gy (IVdose) based on a dose-volume histogram (DVH). The median TD was 35.2 Gy. The median IV20, IV25, IV30, IV35, IV40, and IV45 values were 371.1, 274.8, 233.4, 188.6, 145.8, and 31.0 ml, respectively. The median FLRV was 144.9 ml. There was a significant difference between the FLRV and IV20, IV25, and IV45 (p<0.05), but no significant differences between the FLRV and IV30, IV35, or IV40. These results suggest that the threshold dose of the FLR is approx. 35 Gy in HCC patients who undergo 3D-CRT in 15 fractions. The percentage of the whole liver volume receiving a dose of more than 30-40 Gy (V30-40) is a potential candidate optimal DVH parameter for this fractionation schedule.
AuthorsYoshiyuki Fukugawa, Tomohiro Namimoto, Ryo Toya, Tetsuo Saito, Hideaki Yuki, Tomohiko Matsuyama, Osamu Ikeda, Yasuyuki Yamashita, Natsuo Oya
JournalActa medica Okayama (Acta Med Okayama) Vol. 71 Issue 1 Pg. 25-29 (Feb 2017) ISSN: 0386-300X [Print] Japan
PMID28238007 (Publication Type: Journal Article)
Chemical References
  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA
Topics
  • Aged
  • Carcinoma, Hepatocellular (pathology, radiotherapy)
  • Contrast Media (administration & dosage)
  • Dose-Response Relationship, Radiation
  • Female
  • Gadolinium DTPA (administration & dosage)
  • Humans
  • Image Enhancement
  • Liver (radiation effects)
  • Liver Neoplasms (pathology, radiotherapy)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Radiation Injuries (diagnostic imaging, etiology)
  • Radiotherapy, Conformal (adverse effects)
  • Retrospective Studies

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