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Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

Vorhersagefaktoren bei Magen-Darm-Toxizität basierend auf Endoskopie mit darauffolgender Strahlenbehandlung bei Patienten mit Leberzellkrebs

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Abstract

Purpose

The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT).

Patients and methods

A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30–50 Gy (median 37.5 Gy) in 2–5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the ≥ grade 2 GD toxicity were investigated.

Results

Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V25 for stomach and V35 for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for ≥ grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V25 ≤ 6.3 % and 57.1 % for V25 > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V35 ≤ 5.4 % and 45.9 % for V35 > 5.4 %. By multivariate analysis including the clinical factors, V25 for stomach and V35 for duodenum were the significant factors.

Conclusion

EGD revealed that GD toxicity is common following RT for HCC. V25 for the stomach and V35 for the duodenum were the significant factors to predict ≥ grade 2 GD toxicity.

Zusammenfassung

Ziel

Ziel der Studie war es, Vorhersagefaktoren für Magen-Darm-(GD-)Toxizität bei Patienten mit Leberzellkrebs (HCC) zu bestimmen, die eine Strahlenbehandlung (RT) erhalten hatten.

Patienten und Methoden

In die Studie wurden insgesamt 90 HCC-Patienten aufgenommen, die vor und nach einer RT einer Esophagogastroduodenoskopie (EGD) unterzogen wurden. Es wurden RT-Dosen zwischen 30–50 Gy (Median 37,5 Gy) in Einzeldosen zu je 2–5 Gy (Median 3,5 Gy) verabreicht. Alle endoskopischen Ergebnisse wurden überprüft und die GD-Toxizität in Bezug auf die RT wurde entsprechend den Kriterien der „Common Toxicity Criteria for Adverse Events Version 3.0“ eingestuft. Untersucht wurde die Vorhersagefaktoren für die GD-Toxizität ≥Stufe 2.

Ergebnisse

Die endoskopischen Befunde zeigten eine erosive Gastritis bei 14 Patienten (16 %), Magengeschwüre bei 8 Patienten (9 %), erosive Duodenitis bei 15 Patienten (17 %) und Duodenalgeschwüre bei 14 Patienten (16 %). Eine Stufe-2-Toxizität entwickelte sich bei 19 Patienten (21 %), eine Stufe-3-Toxizität bei 8 Patienten (9 %). V25 für den Magen und V35 für den Zwölffingerdarm hatten die höchsten Vorhersagefaktoren bei einer Toxizität ≥Stufe 2. Die Magentoxizitätsrate bei 6 Monaten betrug 2,9 % für V25 ≤ 6,3 % und 57,1 % für V25 > 6,3 %. Die Zwölffingerdarmtoxizitätsrate bei 6 Monaten war 9,4 % für V35 ≤ 5,4 % und 45,9 % für V35 > 5,4 %. Bei multivariaten Analysen inklusive klinischen Faktoren waren V25 für den Magen und V35 für den Zwölffingerdarm signifikante Faktoren.

Schlussfolgerung

Die EGD hat gezeigt, dass die GD-Toxizität nach einer RT für HCC verbreitet ist. V25 für den Magen und V35 für den Zwölffingerdarm waren signifikante Faktoren zur Vorhersage einer GD-Toxizität ≥Stufe 2.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Health Sciences and Technology, School of Medicine & Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea

    H. Yoon BS

  2. Department of Radiation Oncology, Samsung Medical Center , Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710, Seoul, Korea

    D. Oh MD, H.C. Park MD, PhD, Y. Han PhD & D.H. Lim MD, PhD

  3. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    S.W. Paik MD, PhD

  4. Department of Radiologic Science, Korea University, Seoul, Korea

    S.W. Kang BS

Authors
  1. H. Yoon BS
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  2. D. Oh MD
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  3. H.C. Park MD, PhD
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  4. S.W. Kang BS
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  5. Y. Han PhD
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  6. D.H. Lim MD, PhD
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  7. S.W. Paik MD, PhD
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Corresponding author

Correspondence to H.C. Park MD, PhD.

Additional information

Hyunsik Yoon and Dongryul Oh contributed equally to the article.

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Yoon, H., Oh, D., Park, H. et al. Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma. Strahlenther Onkol 189, 541–546 (2013). https://doi.org/10.1007/s00066-013-0343-0

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  • DOI: https://doi.org/10.1007/s00066-013-0343-0

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