Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance

Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):426-34. doi: 10.1016/j.ijrobp.2005.12.031.


Purpose: To identify risk factors relevant to radiation-induced liver disease (RILD) and to determine the hepatic tolerance to radiation.

Methods and materials: The data of 109 primary liver carcinomas (PLC) treated with hypofractionated three-dimensional conformal radiation therapy (3D-CRT) were analyzed. Seventeen patients were diagnosed with RILD and 13 of 17 died of it.

Results: The risk factors for RILD were late T stage, large gross tumor volume, presence of portal vein thrombosis, association with Child-Pugh Grade B cirrhosis, and acute hepatic toxicity. Multivariate analyses demonstrated that the severity of hepatic cirrhosis was a unique independent predictor. For Child-Pugh Grade A patients, the hepatic radiation tolerance was as follows: (1) Mean dose to normal liver (MDTNL) of 23 Gy was tolerable. (2) For cumulative dose-volume histogram, the tolerable volume percentages would be less than: V5 of 86%, V10 of 68%, V15 of 59%, V20 of 49%, V25 of 35%, V30 of 28%, V35 of 25%, and V40 of 20%. (3) Tolerable MDTNL could be estimated by MDTNL (Gy) = -1.686 + 0.023 * normal liver volume (cm3).

Conclusion: The predominant risk factor for RILD was the severity of hepatic cirrhosis. The hepatic tolerance to radiation could be estimated by dosimetric parameters.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular
  • Dose Fractionation, Radiation
  • Female
  • Humans
  • Liver / radiation effects*
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / pathology
  • Liver Neoplasms / pathology
  • Liver Neoplasms / radiotherapy*
  • Logistic Models
  • Male
  • Maximum Tolerated Dose
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • ROC Curve
  • Radiation Injuries / etiology*
  • Radiation Tolerance / physiology*
  • Radiotherapy, Conformal / adverse effects*
  • Risk Factors