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Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma.

Son SH, Jang HS, Jo IY, Choi BO, Jang JW, Yoon SK, Kay CS - Radiat Oncol (2014)

Bottom Line: We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively).To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Incheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. k41645@chol.com.

ABSTRACT

Background: We attempted to analyze the effects of an increase in the Child-Pugh (CP) score on the overall survival of patients with unresectable hepatocellular carcinoma (HCC) after radiotherapy (RT).

Methods: From March 2006 to February 2012, 103 patients received RT using the TomoTherapy Hi-Art at Incheon St. Mary's Hospital and Seoul St. Mary's Hospital. The dose per fraction was 1.8-5 Gy, and the total dose was 40-60 Gy (median, 50 Gy). We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.

Results: The median follow-up duration was 11.6 months (range, 3.5-85.3 months). The median survival time was 11.6 months. In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively). In a comparison of cases with and without an increase in the CP score, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.

Conclusion: An increase of at least 2 points in the CP score within 3 months of RT completion is an important on-treatment factor that affects overall survival. To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

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Related in: MedlinePlus

Survival curves according to the presence or absence of an increase in the CP score.
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Figure 1: Survival curves according to the presence or absence of an increase in the CP score.

Mentions: An increase of at least 2 points in the CP score was noted in 47 of the 103 patients (45.6%) after a median time of 1.7 months (range, 0.8–3.0 months) after RT completion. Among these 47 patients, 5 patients (10.6%) recovered from a CP score increase after a median time of 2.73 months (range, 2.53–3.0 months) after RT completion. However, such recoveries were transient because the CP scores increased again after a median time of 0.9 months (range, 0.13–1.13 months). In the absence of an increase of at least 2 points in the CP score, the median survival time was 17.9 months, and the 1-, 2-, and 3-year survival rates were 66.1%, 34.7%, and 22.1%, respectively. In the presence of an increase of at least 2 points in the CP score, the median survival time was 6.9 months, and the 1-, 2-, and 3-year survival rates were 27.7%, 10.2%, and 5.1%, respectively (Figure 1). In a comparison between cases with increased CP scores and those without increased CP scores, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.


Significance of an increase in the Child-Pugh score after radiotherapy in patients with unresectable hepatocellular carcinoma.

Son SH, Jang HS, Jo IY, Choi BO, Jang JW, Yoon SK, Kay CS - Radiat Oncol (2014)

Survival curves according to the presence or absence of an increase in the CP score.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016647&req=5

Figure 1: Survival curves according to the presence or absence of an increase in the CP score.
Mentions: An increase of at least 2 points in the CP score was noted in 47 of the 103 patients (45.6%) after a median time of 1.7 months (range, 0.8–3.0 months) after RT completion. Among these 47 patients, 5 patients (10.6%) recovered from a CP score increase after a median time of 2.73 months (range, 2.53–3.0 months) after RT completion. However, such recoveries were transient because the CP scores increased again after a median time of 0.9 months (range, 0.13–1.13 months). In the absence of an increase of at least 2 points in the CP score, the median survival time was 17.9 months, and the 1-, 2-, and 3-year survival rates were 66.1%, 34.7%, and 22.1%, respectively. In the presence of an increase of at least 2 points in the CP score, the median survival time was 6.9 months, and the 1-, 2-, and 3-year survival rates were 27.7%, 10.2%, and 5.1%, respectively (Figure 1). In a comparison between cases with increased CP scores and those without increased CP scores, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.

Bottom Line: We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively).To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Incheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. k41645@chol.com.

ABSTRACT

Background: We attempted to analyze the effects of an increase in the Child-Pugh (CP) score on the overall survival of patients with unresectable hepatocellular carcinoma (HCC) after radiotherapy (RT).

Methods: From March 2006 to February 2012, 103 patients received RT using the TomoTherapy Hi-Art at Incheon St. Mary's Hospital and Seoul St. Mary's Hospital. The dose per fraction was 1.8-5 Gy, and the total dose was 40-60 Gy (median, 50 Gy). We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.

Results: The median follow-up duration was 11.6 months (range, 3.5-85.3 months). The median survival time was 11.6 months. In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively). In a comparison of cases with and without an increase in the CP score, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.

Conclusion: An increase of at least 2 points in the CP score within 3 months of RT completion is an important on-treatment factor that affects overall survival. To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

Show MeSH
Related in: MedlinePlus