Predictive factors for Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy: Dose-volume histogram analysis

Aims and background. We designed the study to identify the clinical and dose-volumetric parameters associated with the risk of Child-Pugh score elevation in hepatocellular carcinoma patients treated with conformal radiation therapy. Methods and study design. All 161 hepatocellular carcinoma patients in the study underwent 4D-computed tomography simulation, and a dose-volume histogram was generated after radiotherapy planning. Patients who had an elevated Child-Pugh (e- CP) score of 2 or more without progressive disease within 3 months were defined as e-CP positive. Results. Twenty-six of 142 patients without progressive disease were e-CP positive. Pretreatment Child-Pugh class, further treatment within 30 days of radiotherapy, lymph node metastasis, mean liver dose, V_20Gy, V_25Gy, and V_30Gy were significantly correlated with e-CP positivity. The e-CP developed in 13 of 106 patients (12.3%) with V_30Gy of ≤28.1% and in 13 of 36 patients (36.1%) with V_30Gy >28.1% (P = 0.001). Conclusions. Our data demonstrate that mean liver dose, V_10Gy, V_20Gy , V _25Gy , and V30Gy are independent dose-volumetric predictors for e-CP positivity in hepatocellular carcinoma patients treated with conformal radiation therapy. V_30Gyshould be limited to less than 28.1% to minimize the risk of e-CP.