肝细胞癌低分割螺旋断层放射治疗后非典型放射性肝病的预测因素分析

Predictive factors of nonclassic radiation-induced liver disease after hypofractioned helical tomotherapy in hepatocelluar carcinoma

目的探讨临床和剂量学参数与肝细胞癌(hepatocellular carcinoma,HCC)低分割螺旋断层放射治疗(helical tomotherapy,HT)后是否发生放射性肝病(radiation-induced liver disease,RILD)的关系。方法纳入2011年6月至2015年6月于复旦大学附属中山医院放疗科接受HT治疗的40例HCC患者。收集入组患者的临床信息和剂量-体积直方图(dose-volume histogram,DVH)资料并进行统计分析。评估患者放疗前后的肝脏功能情况,利用Logistic模型分析与RILD有关的危险因素。受试者工作特征(receiver operating characteristic,ROC)曲线获取最佳界值。结果本研究纳入的40例HCC患者中,男性38例(95.0%),女性2例(5.0%),中位年龄52岁(22~86岁)。临床分期Ⅰ期8例(20.0%),Ⅱ期8例(20.0%),Ⅲ期13例(32.5%),Ⅳ期11例(27.5%)。肝功能Child-Pugh分级均为A。HT的中位总剂量为53.8 Gy(28.6~63.0 Gy)。发生非典型RILD的患者为8例(20.0%),通过Logistic回归模型分析发现正常肝平均剂量(mean dose to normal liver,MDTNL)可能是非典型RILD的独立危险因素(OR=1.941,95%CI:1.023~3.679,P=0.042)。其ROC曲线的最佳界值为21.06 Gy(敏感度:100%,特异度:84.4%)。结论MDTNL与HCC患者接受低分割HT后是否发生非典型RILD具有相关性,可能是预测因素,MDTNL<21.06 Gy对于评价放疗计划具有一定的参考价值。

Objective To analyze the relationship between the clinical and dosimetric parameters and radiation-induced liver disease(RILD)of hepatocellular carcinoma(HCC)patients who received hypofractioned helical tomotherapy(HT).Methods From Jun 2011 to Jun 2015,a total of 40 HCC patients who received hypofractioned HT in Zhongshan Hospital,Fudan University were enrolled.Clinical characteristics and dose-volume histogram(DVH)were collected.Liver functions were evaluated before and after radiotherapy.Binary Logistics and optimal cut-off value of receiver operating characteristic(ROC)curve were engaged to analyze the risk factor of RILD.Results Among the 40 HCC patients,38(95.0%)were male and 2(5.0%)were female,with a median age of 52(22-86)years old.There were 8(20.0%),8(20.0%),13(32.5%)and 11(27.5%)patients with clinical stageⅠtoⅣrespectively.All patients were Child-Pugh A.The median dose was 53.8 Gy(range from 28.6 Gy to 63.0 Gy).We observed that the mean dose to normal liver(MDTNL)was independent risk factor via multivariate binary Logistic analyses[OR=1.941,95%CI:1.023-3.679,P=0.042].The optimal cut-off value of ROC curve for MDTNL was 21.06 Gy;the sensitivity and specificity of the dichotomized MDTNL were 100%and 84.4%,respectively.Conclusion MDTNL may be an independent predicting factor for nonclassic RILD after hypofractioned HT in HCC patients.MDTNL<21.06 Gy may be used as reference for radiotherapy planning.