The effect of stereotactic body radiation therapy for hepatocellular cancer on regional hepatic liver function Journal Article


Authors: Wei, L.; Simeth, J.; Aryal, M. P.; Matuszak, M.; Haken, R. K. T.; Cuneo, K.; Lawrence, T. S.; Cao, Y.
Article Title: The effect of stereotactic body radiation therapy for hepatocellular cancer on regional hepatic liver function
Abstract: Purpose: To investigate direct radiation dose–related and inflammation-mediated regional hepatic function losses after stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC) and poor liver function. Methods and Materials: Twenty-four patients with HCC enrolled on an IRB-approved adaptive SBRT trial had liver dynamic gadoxetic acid–enhanced magnetic resonance imaging and blood sample collections before and 1 month after SBRT. Gadoxetic acid uptake rate (k1) maps were quantified for regional hepatic function and coregistered to both 2-Gy equivalent dose and physical dose distributions. Regional k1 loss patterns from before to after SBRT were analyzed for effects of dose and patient using a mixed-effects model and logistic function and were associated with pretherapy liver-function albumin-bilirubin scores. Plasma levels of tumor necrosis factor α receptor 1 (TNFR1), an inflammation marker, were correlated with mean k1 losses in the lowest dose regions by Spearman rank correlation. Results: The whole group had a k1 loss rate of 0.4%/Gy (2-Gy equivalent dose); however, there was a significant random effect of patient in the mixed-effect model (P < .05). Patients with poor and good liver functions lost 50% of k1 values at 12.5 and 57.2 Gy and 33% and 16% of k1 values at the lowest dose regions (<5 Gy), respectively. The k1 losses at the lowest dose regions of individual patients were significantly correlated with their TNFR1 levels after SBRT (P < .02). Conclusions: The findings suggest that regional hepatic function losses after SBRT in patients with HCC include both direct radiation dose–dependent and inflammation-mediated effects, which could influence how to manage these patients to preserve their liver function after SBRT. © 2022 Elsevier Inc.
Keywords: hepatocellular carcinoma; magnetic resonance imaging; cell death; radiotherapy; pathology; radiation effects; stereotactic body radiation therapy; low dose; equivalent dose; receptor-1; tumor necrosis factors; random processes; liver functions; hepatic function; mixed effects models; direct radiations
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 115
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2023-03-01
Start Page: 794
End Page: 802
Language: English
DOI: 10.1016/j.ijrobp.2022.09.077
PUBMED: 36181992
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 February 2023 -- Source: Scopus
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  1. Josiah J. Simeth
    6 Simeth