Towards consensus reporting of radiation-induced liver toxicity in the treatment of primary liver malignancies: defining clinically relevant endpoints

Publication date: Available online 4 November 2017
Source:Practical Radiation Oncology
Author(s): Tobias R. Chapman, Stephen R. Bowen, Stephanie K. Schaub, Rosanna H. Yeung, Sharon W. Kwan, James O. Park, Lei Yu, William P. Harris, Guy E. Johnson, Iris W. Liou, Matthew J. Nyflot, Smith Apisarnthanarax
Background and PurposeTo define the most clinically relevant "non-classic" radiation-induced liver disease (ncRILD) endpoints in cirrhotic patients receiving stereotactic body radiotherapy (SBRT) or proton beam therapy (PBT) for primary liver cancer.Material and MethodsWe retrospectively collected pre-treatment, detailed toxicity (≤6 months post-treatment), and outcomes data from 48 patients. Deaths were examined for association with RILD. Univariate (UA) and multivariate (MA) Cox models defined significant predictors of overall survival (OS)/RILD-specific survival (RILD-SS).ResultsWith median follow-up of 13 months, 23 patients (48%) had an increase in CP score (≥2, 25%) and three (6%) had ≥G3 transaminase elevation. Of 18 deaths, 6 were potentially ascribed to RILD. On UA, CP score increases of ≥1, ≥2 and CP class change predicted OS, as did ≥G3 AST elevation and ≥1 CTCAE AST toxicity grade change. On MA, CP score increase of ≥2 and ≥1 CTCAE AST toxicity grade change were the strongest independent ncRILD predictors of OS. For RILD-SS, CP score increases of ≥2, ≥G3 CTCAE ALT and ≥G2 bilirubin elevations were predictive.ConclusionsIncreased CP score of ≥2 strongly predicts of both OS and RILD-SS, and should be reported in future studies along with transaminase elevations, which are also predictive of outcomes.



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