Dose-Volume Analysis for 4 Patients with Radiation-Induced Liver Disease after 3-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma

四例肝細胞癌病人接受三度空間隨形放射線治療後發生放射線引起之肝病變的劑量－體積分析

成佳憲(Jason Chia-Usien Chengt) ； 吳簡坤(Jian-Kuen Wu) ； 黃昭明(Jones Chao-Ming Huang) ； 鄭鴻鈞(Skye Hongiun Cheng) ； 黃英強(David Huang) ； 簡哲民(James Jer-Min Jian) ； 楊博勝(Po-Sheng Yang)

《放射治療與腫瘤學》 6卷1期 (1999/03) Pp. 55-61

https://doi.org/10.6316/TRO/199906(1)55

摘要

目的：針對目前發表之幾種肝臟放射線治療後預測放射線引起之肝病變的機率模式，評估其實用性與準確性。
材料與方法：1994年4月至1998年10月，四位肝細胞癌病人接受三度空間隨形放射線治療後，三個月內產生放射線引起之肝病變。四位病人治療前皆接受了電腦斷層模擬定位，且影像資訊均涵蓋整個肝臟。由劑量－禮積關係圖中求得V(下標 30Gy)，V(下標 50%)，V(下標 off)與PS幾項參數，再由幾種預測模式換算出產生放射線引起之肝臟病變機率。
結果：四位發生放射線引起之肝病變病人中，二位死於此併發症，另二位復原。二位死於併發症的病人正常肝臟超過30Gy的體積均小於50%，而存活的二位病人超過30Gy的肝臟則大於50%。四位病人中的三位其放射線劑量皆符合密西根大學醫學中心依據V(下標 50%)的建議劑量。依據正常組織併發症機率模式分析，若應用0.69為體積效應參數，四位病人的併發症機率均在5%以下，若應用0.32為參數，則機率為5-20%。
結論：目前發表的幾種對放射線引起之肝病變的機率預測模式，均不能準確評估台灣肝細胞癌病人接受放射線治療後的併發症機率。利用目前使用的放射治療療程設計及劑量－禮積資料，建立一套適合台灣肝細胞癌病人併發症預測模式，是有其必要性的。

關鍵字

肝細胞癌 ； 放射線治療 ； 放射線引起之肝病變

並列摘要

Purpose: To evaluate the feasibility and accuracy of the currently documented models for prediction of radiation -induced liver disease (RILD), for patients with hepatocellular carcinoma (HCC) treated with 3-dimensional conformal radiotherapy.
Materials and Methods: From September 1994 to October 1998, four patients with HCC developed FOLD within 3 months after completion of 3-dimensional conformal radiotherapy. All patients had CT simulation with the images including the entire liver. The detailed information from the dose-volume histogram (DVH), including V(subscript 30Gy), V(subscript 50%) V (subscript off) and prediction score (PS), were calculated and assessed. The complication probabilities were compared with several documented models.
Results: Two patients died of RILD-related hepatic failure and 2 recovered. Two patients had more than half of the liver with ＞ 30 cay survived but the other 2 patients died of RILD with 40% and 23% of the liver receiving ＞ 30 Gy. Three of 4 patient had the recommended doses of radiation based on the calculated V(subscript 60%). According to the normal tissue complication probability (NTCP) model, the complication probabilities were less than 5% and within 5-20% if 0.69 and 0.32 were applied for the volume effect parameters, respectively.
Conclusion: All the currently documented models fail to accurately estimate the probability of FOLD for the 4 patients with HCC treated with 3-dimensional conformal radiotherapy. It is indicated to establish a model for patients with HCC in Taiwan, using the currently available fractionation and the information from the DVH.

並列關鍵字

Hepatocellular carcinoma ； Radiotherapy ； Radiation-induced liver disease