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Effect of CyberKnife stereotactic body radiation therapy for hepatocellular carcinoma on hepatic toxicity

Authors Liang P, Huang C, Liang S, Li Y, Huang S, Lian Z, Liu J, Tang Y, Lu H

Received 8 May 2016

Accepted for publication 23 September 2016

Published 18 November 2016 Volume 2016:9 Pages 7169—7175

DOI https://doi.org/10.2147/OTT.S112290

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ru Chen

Peer reviewer comments 3

Editor who approved publication: Dr Yao Dai


Ping Liang,1,* Cheng Huang,2,* Shi-Xiong Liang,2,3 Ye-Fei Li,3 Shang-Xiao Huang,2 Zu-Ping Lian,1 Jian-Min Liu,1 Yang Tang,1 Hai-Jie Lu4

1Department of Radiation Oncology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, 2Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning, 3Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 4Department of Radiation Oncology, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, People’s Republic of China

*These authors contributed equally to this work


Objective: To evaluate the safety of CyberKnife stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) patients and identify the treatment-related risk factors of hepatic toxicity.
Materials and methods: One hundred and four HCC patients treated with CyberKnife SBRT were included in this study between August 2009 and December 2012. The average dose of prescribed radiation was 42.81±4.78 Gy (28–55 Gy) with the average fraction size of 8–16 Gy to the planning target volume. The average fractions were 3.31±0.81 (2–6 fractions). Response rates were determined, and the Child–Pugh (CP) score and class following CyberKnife SBRT were obtained to evaluate hepatic toxicity.
Results: Seventeen patients experienced progression in CP class and 24 patients experienced CTCAE V. 4.0 grade 2–3 hepatic toxicity during the five-month follow-up period, while no patient experienced grade 4 liver toxicity. Multivariate analysis indicated that only V25 was an independent factor in grade 2–3 hepatic toxicity (P=0.029, <0.05). Radiation-induced hepatic toxicity (RIHT), defined as an increase of at least two points within three months following CyberKnife SBRT, occurred in 13 of the 104 patients (13/104, 12.5%), and only the normal liver tissue was found to be associated with RIHT (P=0.008, <0.05).
Conclusion: CyberKnife SBRT is a feasible and safe treatment for HCC with regard to hepatic toxicity, while V25 and normal liver volume may be an independent factor of grade 2–3 hepatic toxicity and RIHT, respectively.

Keywords: hepatocellular carcinoma, hepatic toxicity, CyberKnife stereotactic body radiation therapy (SBRT)

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