Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Son, Seung Hyun; Jang, Hong Seok; Jo, In-Young; Choi, Byung Ock; Jang, Jeong Won; Yoon, Seung Kew; Kay, Chul Seung

doi:10.1186/1748-717x-9-101

Cited by 24 publications

(16 citation statements)

References 23 publications

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“…Previous studies have attempted to identify radiographic and dosimetric predictors of liver toxicity; the percentage of liver volume receiving more than 30 Gy, percentage of lung volume receiving more than 20 Gy, pretreatment hepatopulmonary shunt fraction, and pretreatment liver cirrhosis have all been independently associated with liver toxicity following SIRT ( 36 – 42 ). A recent report demonstrated that a 2+ change in CP score is a clinically important indicator of decline in liver function and survival in patients with unresectable HCC who have received radiotherapy ( 15 ). This finding is supported by the survival data in our current study.…”

Section: Discussionmentioning

confidence: 99%

“…Child-Pugh (CP) score was used to assess changes in liver function after SIRT. An increase in CP score by two or more points was deemed to be a clinically relevant indicator of decline in liver function following radiotherapy in one prior analysis ( 15 ). For data analysis purposes, changes in liver function were expressed as a binary value at 3 and 6 months post-SIRT: patients with a 2+ increase in CP score from baseline were given a 1 at each follow-up point; those with a score increase of <2 were given a 0.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma

et al. 2015

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PurposeWe sought to report outcomes and toxicity in patients with hepatocellular carcinoma (HCC) who received resin yttrium-90 selective internal radiation therapy (90Y-SIRT) and to identify factors associated with declining liver function.MethodsPatients treated with 90Y-SIRT were retrospectively evaluated. Radiographic response was assessed using RECIST 1.1. Median liver progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Bivariate analysis was used to examine associations between change in Child-Pugh (CP) score/class and patient characteristics and treatment parameters.ResultsTwenty-seven patients with unresectable HCC underwent SIRT, 52% were CP Class A, 48% were Class B, 11% were BCLC stage B, and 89% were stage C. Forty-four percent of patients had portal vein thrombus at baseline. One-third of patients received bilobar treatment. Median activity was 32.1 mCi (range 9.18–43.25) and median-absorbed dose to the liver was 39.6 Gy (range 13.54–67.70). Median LPFS and OS were 2.5 and 11.7 months, respectively. Three-month disease control rate was 63 and 52% in the target lesions and whole liver, respectively. New onset or worsened from baseline clinical toxicities were confined to Grade 1–2 events. However, new or worsened Grade 3–4 laboratory toxicities occurred in 38% of patients at 3 months and 43% of patients at 6 months following SIRT (six had lymphocytopenia, three had hypoalbuminemia, and two had transaminasemia). After 3 months, six patients had worsened in CP score and five had worsened in class from baseline. After 6 months, four patients had worsened in CP score and one had worsened in class from baseline. Pretreatment bilirubinemia was associated with a 2+ increase in CP score within 3 months (P = 0.001) and 6 months (P = 0.039) of 90Y-SIRT. Pretreatment transaminasemia and bilirubinemia were associated with increased CP class within 3 months of SIRT (P = 0.021 and 0.009, respectively).Conclusion90Y-SIRT was well-tolerated in patients with unresectable HCC, with no Grade 3–4 clinical toxicities. However, Grade 3–4 laboratory toxicities and worsened CP scores were more frequent. HCC patients with pretreatment bilirubinemia or transaminasemia may be at higher risk of experiencing a decline in liver function following 90Y-SIRT.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma

et al. 2015

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“…Change of Child-Pugh score after RT was also evaluated. If there was change in Child-Pugh score of 2 or more points, it was considered as development of complication [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

Bae

Kim

2016

Radiat Oncol J

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PurposeThe purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated.Materials and MethodsForty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated.ResultsThe median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients’ prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively).ConclusionRT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

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“…Tumor response was defined as the best response in the dynamic CT scans obtained 1 month and 3 months after RT, according to the modified Response Evaluation Criteria in Solid Tumors [ 27 ]. PFS was measured from the date of RT to the date of progression or the last follow-up.…”

Section: Methodsmentioning

confidence: 99%

Identifying the optimal criteria of radiotherapeutic parameters for patients with unresectable locally advanced hepatocellular carcinoma

et al. 2015

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The purpose of this study is to identify the optimal criteria of the radiotherapeutic parameters in patients with unresectable locally advanced hepatocellular carcinoma (HCC). 103 patients were enrolled in this study. All patients received RT delivered using the TomoTherapy Hi-Art system between March 2006 and February 2012. We evaluated the planning target volume (PTV), total dose (Gy10), and NTNL-VBED20 (non-target normal liver volume receiving more than a biologically effective dose of 20 Gy8) as significant radiotherapeutic parameters associated with hepatic function deterioration and local progression-free survival (PFS). A PTV of 279 cm3 or 304 cm3, a total dose of 60 Gy10, and a NTNL-VBED20 of 40.8% were identified as the optimal cut-off values of radiotherapeutic parameters to prevent hepatic function deterioration and prolong local PFS. Based on these findings, patients were divided in a favorable and an unfavorable prognosis group. The differences in median local PFS, overall survival, and incidence of deteriorated hepatic function between the two groups were 11.2 months, 11.1 months, and 71.7%, respectively (p < 0.001 in each case). In conclusion, we suggest that the optimal criteria of the radiotherapeutic parameters for patients with unresectable locally advanced HCC are: PTV ≤ 279 cm3, total dose > 60 Gy10, and NTNL-VBED20 ≤ 40.8%.

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Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma

Cited by 24 publications

References 23 publications

Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma

Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma

The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

Identifying the optimal criteria of radiotherapeutic parameters for patients with unresectable locally advanced hepatocellular carcinoma

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