This study was designed to evaluate the prevalence of gastroduodenal complications and factors that contribute to the development of symptomatic GD toxicity in cirrhotic patients with perihilar hepatocellular carcinoma (HCC), after an acceptable dose of radiotherapy.
Methods
This was a retrospective study of 40 cirrhotic patients with perihilar HCC treated with radiotherapy from August 2008 to September 2010. Esophagogastroduodenoscopy was performed before and after radiotherapy. The maximum point dose to the gastroduodenum was 35.8 to 44 Gy (2 Gy equivalent, α/β = 10). Gastroduodenal complications were graded using the Common Terminology Criteria for Adverse Events (CTCAE; version 3.0). Child-Pugh score was assessed 3 months after completion of radiotherapy, and compared with the score obtained before radiotherapy.
Results
Gastroduodenal complications were observed in 22 patients (55.0%) after radiotherapy. Twelve of these patients (30%) needed medical interventions. Although there were no significant factors that directly correlated with the prevalence of allgrade gastroduodenal complications, symptomatic complications (grade 2 or higher) were significantly related to the degree of Child-Pugh score elevation after radiotherapy (P = 0.002).
Conclusions
Considerable gastroduodenal complications developed in cirrhotic patients with perihilar HCC after an acceptable dose of radiotherapy. The aspects of gastroduodenal toxicities and the maintenance of liver function after radiotherapy may be an important issue in patients who undergo this treatment.
YuJ.I., ParkH.C., Lim doH., ParkW., YooB.C., PaikS.W., KohK.C., LeeJ.H.: Prognostic index for portal vein tumor thrombosis in patients with hepatocellular carcinoma treated with radiation therapy.J Korean Med Sci, 26: 1014–1022, 2011.
5.
KimY.I., ParkH.C., Lim doH., ParkH.J., KangS.W., ParkS.Y., KimJ.S., HanY., PaikS.W.: Changes of the liver volume and the Child-Pugh score after high dose hypofractionated radiotherapy in patients with small hepatocellular carcinoma.Radiat Oncol J, 30: 189–196, 2012.
6.
ParkH.C., SeongJ., HanK.H., ChonC.Y., MoonY.M., SuhC.O.: Dose-response relationship in local radiotherapy for hepatocellular carcinoma.Int J Radiat Oncol Biol Phys, 54: 150–155, 2002.
7.
TseR.V., HawkinsM., LockwoodG., KimJ.J., CummingsB., KnoxJ., ShermanM., DawsonL.A.: Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma.J Clin Oncol, 26: 657–664, 2008.
8.
ChengJ.C., WuJ.K., HuangC.M., HuangD.Y., ChengS.H., LinY.M., JianJ.J., YangP.S., ChuangV.P., HuangA.T.: Radiation-induced liver disease after radiotherapy for hepatocellular carcinoma: clinical manifestation and dosimetric description.Radiother Oncol, 63: 41–45, 2002.
ChonY.E., SeongJ., KimB.K., ChaJ., KimS.U., ParkJ.Y., AhnS.H., HanK.H., ChonC.Y., ShinS.K., Kim doY.: Gastroduodenal complications after concurrent chemoradiation therapy in patients with hepatocellular carcinoma: endoscopic findings and risk factors.Int J Radiat Oncol Biol Phys, 81: 1343–1351, 2011.
11.
ChangD.T., SchellenbergD., ShenJ., KimJ., GoodmanK.A., FisherG.A., FordJ.M., DesserT., QuonA., KoongA.C.: Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas.Cancer, 115: 665–672, 2009.
12.
RaoulJ.L.: Natural history of hepatocellular carcinoma and current treatment options.Semin Nucl Med, 38: S13–18, 2008.
13.
RudlerM., RousseauG., BenosmanH., MassardJ., DeforgesL., LebrayP., PoynardT., ThabutD.: Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?Aliment Pharmacol Ther, 36: 166–172, 2012.
14.
KamathP.S., LacerdaM., AhlquistD.A., McKusickM.A., AndrewsJ.C., NagorneyD.A.: Gastric mucosal responses to intrahepatic portosystemic shunting in patients with cirrhosis.Gastroenterology, 118: 905–911, 2000.
15.
KimH., Lim doH., PaikS.W., YooB.C., KohK.G., LeeJ.H., ChoiM.S., ParkW., ParkH.C., HuhS.J., ChoiD.H., AhnY.C.: Predictive factors of gastroduodenal toxicity in cirrhotic patients after three-dimensional conformal radiotherapy for hepatocellular carcinoma.Radiother Oncol, 93: 302–306, 2009.
16.
YuJ.I., KimJ.S., ParkH.C., LimD.H., HanY.Y., LimH.C., PaikS.W.: Evaluation of anatomical landmark position differences between respiration-gated MRI and four-dimensional CT for radiation therapy in patients with hepatocellular carcinoma.Br J Radiol, 86: 20120221, 2013.
17.
BujoldA., MasseyC.A., KimJ.J., BrierleyJ., ChoC., WongR.K., DinniwellR.E., KassamZ., RingashJ., CummingsB., SykesJ., ShermanM., KnoxJ.J., DawsonL.A.: Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma.J Clin Oncol, 31: 1631–1639, 2013.
18.
MornexF., GirardN., BeziatC., KubasA., KhodriM., TrepoC., MerleP.: Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies—mature results of the French phase II RTF-1 trial.Int J Radiat Oncol Biol Phys, 66: 1152–1158, 2006.
19.
ParkW., LimD.H., PaikS.W., KohK.C., ChoiM.S., ParkC.K., YooB.C., LeeJ.E., KangM.K., ParkY.J., NamH.R., AhnY.C., HuhS.J.: Local radiotherapy for patients with unresectable hepatocellular carcinoma.Int J Radiat Oncol Biol Phys, 61: 1143–1150, 2005.
20.
ZamboglouC., MessmerM.B., BeckerG., MommF.: Stereotactic radiotherapy in the liver hilum. Basis for future studies.Strahlenther Onkol, 188: 35–41, 2012.
21.
Gonzalez-GonzalezJ.A., Garcia-CompeanD., Vazquez-ElizondoG., Garza-GalindoA., Jaquez-QuintanaJ.O., Maldonado-GarzaH.: Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study.Ann Hepatol, 10: 287–295, 2011.
22.
KirchnerG.I., BeilW., BleckJ.S., MannsM.P., WagnerS.: Prevalence of Helicobacter pylori and occurrence of gastroduodenal lesions in patients with liver cirrhosis.Int J Clin Exp Med, 4: 26–31, 2011.
23.
TsaiC.J.: Helicobacter pylori infection and peptic ulcer disease in cirrhosis.Dig Dis Sci, 43: 1219–1225, 1998.
24.
WuC.S., LinC.Y., LiawY.F.: Helicobacter pylori in cirrhotic patients with peptic ulcer disease: a prospective, case controlled study.Gastrointest Endosc, 42: 424–427, 1995.
25.
GuslandiM., FoppaL., SorghiM., PellegriniA., FantiL., TittobelloA.: Breakdown of mucosal defences in congestive gastropathy in cirrhotics.Liver, 12: 303–305, 1992.
26.
MezawaS., HommaH., OhtaH., MasukoE., DoiT., MiyanishiK., TakadaK., KukitsuT., SatoT., NiitsuY.: Effect of transjugular intrahepatic portosystemic shunt formation on portal hypertensive gastropathy and gastric circulation.Am J Gastroenterol, 96: 1155–1159, 2001.
27.
ArakawaT., SatohH., FukudaT., NakamuraH., KobayashiK.: Endogenous prostaglandin E2 in gastric mucosa of patients with alcoholic cirrhosis and portal hypertension.Gastroenterology, 93: 135–140, 1987.
28.
YuJ.I., ParkH.C., LimD.H., ParkW.Y.: Predictive factors for Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy: dosevolume histogram analysis.Tumori, 99: 164–171, 2013.
