Analysis of the factors affecting the safety of robotic stereotactic body radiation therapy for hepatocellular carcinoma patients

Figures & data

Table 1 Characteristics of 74 HCC patients

Characteristics	Number of cases (%)
Sex
Male	56 (75.7)
Female	18 (24.3)
Age (years)
≤60	40 (54.1)
>60	34 (45.9)
ECOG scale
0 and 1 scores	70 (94.6)
2 score	4 (5.4)
History of hepatitis B
Yes	62 (83.8)
No	12 (16.2)
BCLC staging
0	15 (20.3)
A	59 (79.7)
Prior TACE
Yes	12 (16.2)
No	62 (83.8)
GTV (mL)
≤7.5	14 (18.9)
>7.5	60 (81.1)
Total liver volume (mL)
≤1,162	25 (33.8)
>1,162	49 (66.2)
Normal liver volume (mL)
≤1,148	29 (39.2)
>1,148	45 (60.8)
Number of lesions
1	67 (90.5)
>1	7 (9.5)
Intrahepatic progression
Yes	12 (16.2)
No	62 (83.8)

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; ECOG, Eastern Cooperative Oncology Group; GTV, gross tumor volume; HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization.

Table 2 Dosimetric parameters in 74 HCC patients

Dosimetric parameters	Mean	Median
GTV (mL)	31.08±27.69	25.17
Total liver volume (mL)	1,293.28±270.67	1,268.40
Normal liver volume (mL)	1,243.72±265.22	1,246.29
V5 (%)	60.70±21.52	61.34
V10 (%)	35.61±18.52	32.19
V15 (%)	21.67±13.66	17.79
V20 (%)	14.24±9.27	11.32
V25 (%)	10.14±6.86	8.07
V30 (%)	7.46±5.35	6.09

Note: V₅, V₁₀, V₁₅, V₂₀, V₂₅, and V₃₀ indicate detailed dosimetric parameters involving the percentage of normal liver volume receiving 5, 10, 15, 20, 25, and 30 Gy, respectively.

Abbreviations: GTV, gross tumor volume; HCC, hepatocellular carcinoma.

Table 3 Analysis of dosimetric parameters, changes in CTP classification and the occurrence of hepatic adverse reactions in 74 HCC patients

Dosimetric parameters	Changes in CTP classification		P-value	Hepatic adverse reactions		P-value
	No	Yes		Grades 0–1	Grades 2–3
GTV (mL)	32.83±27.98	25.93±26.13	0.510	32.82±28.84	28.62±22.19	0.623
Total liver volume (mL)	1,297.11±263.19	1,216.67±345.72	0.729	1,327.79±273.34	1,131.31±194.03	0.016
Normal liver volume (mL)	1,246.97±255.86	1,217.35±353.27	0.768	1,277.22±265.37	1,086.82±208.44	0.018
V5 (%)	61.23±21.30	56.36±24.31	0.549	60.01±21.50	63.96±22.15	0.552
V10 (%)	35.04±18.65	32.12±18.20	0.576	35.15±18.64	37.80±18.51	0.642
V15 (%)	22.00±13.88	18.87±12.02	0.543	21.35±13.69	23.18±13.94	0.664
V20 (%)	14.41±9.39	12.88±8.60	0.662	13.86±9.03	16.04±10.51	0.445
V25 (%)	10.25±6.95	9.23±6.37	0.695	9.90±6.85	11.25±7.09	0.524
V30 (%)	7.56±5.43	6.62±4.83	0.642	7.39±5.49	7.81±4.86	0.800

Note: V₅, V₁₀, V₁₅, V₂₀, V₂₅, and V₃₀ indicate detailed dosimetric parameters involving the percentage of normal liver volume receiving 5, 10, 15, 20, 25, and 30 Gy, respectively.

Abbreviations: CTP, Child–Turcotte–Pugh; GTV, gross tumor volume; HCC, hepatocellular carcinoma.

Table 4 Analysis of patients’ characteristics in CTP classification and the occurrence of hepatic adverse reactions in 74 HCC patients

Characteristics	Patients (n)	Changes in CTP classification		P-value	Patients (n)	Hepatic adverse reactions		P-value
		No	Yes			Grades 0–1	Grades 2–3
Sex				0.697				0.810
Male	56	49	7		56	47	9
Female	18	17	1		18	14	4
Age (years)				1.000				0.987
≤60	40	36	4		40	33	7
>60	34	30	4		34	28	6
ECOG scale				0.911				1.000
0 and 1 scores	70	63	7		70	58	12
2 score	4	3	1		4	3	1
History of hepatitis B				1.000				0.745
Yes	62	55	7		62	52	10
No	12	11	1		12	9	3
BCLC staging				0.080				1.000
0	15	11	4		15	12	3
A	59	55	4		59	49	10
Prior TACE				0.837				0.929
Yes	12	10	2		12	10	2
No	62	56	6		62	51	11
GTV (mL)				0.058				1.000
≤7.5	14	10	4		14	12	2
>7.5	60	56	4		60	49	11
Total liver volume (mL)				0.155				0.008
≤1,162	25	20	5		25	16	9
>1,162	49	46	3		49	45	4
Normal liver volume (mL)				0.295				0.015
≤1,148	29	24	5		29	20	9
>1,148	45	42	3		45	41	4
Number of lesions				1.000				0.185
1	67	60	7		67	57	10
>1	7	6	1		7	4	3
Intrahepatic progression				0.837				0.614
Yes	12	10	2		12	11	1
No	62	56	6		62	50	12

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; CTP, Child–Turcotte–Pugh; ECOG, Eastern Cooperative Oncology Group; GTV, gross tumor volume; HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization.

Table 5 Logistic regression analysis of related factors affecting ≥ grade 2 hepatic adverse reactions after SBRT treatment

Variables	β	SE	Wald	P-value	RR	95% CI
Sex	0.400	0.674	0.353	0.553	1.492	0.398–5.587
Age (years)	0.010	0.613	0.085	0.987	1.010	0.304–3.353
ECOG scale	0.477	1.197	0.159	0.690	1.611	0.154–16.842
History of hepatitis B	0.550	0.751	0.537	0.464	0.577	0.132–2.513
BCLC staging	0.203	0.733	0.077	0.782	0.816	0.194–3.433
Prior of TACE	0.076	0.843	0.008	0.929	1.078	0.207–5.267
GTV (mL)	0.298	0.833	0.128	0.721	1.347	0.263–6.899
Total liver volume (mL)	−1.806	0.665	7.388	0.007	0.164	0.045–0.604
Normal liver volume (mL)	−1.504	0.658	5.230	0.022	0.222	0.061–0.806
Number of lesions	1.453	0.837	3.011	0.083	4.257	0.829–22.057
Intrahepatic progression	0.083	0.722	0.013	0.908	0.920	0.223–3.790

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; GTV, gross tumor volume; RR, relative risk; SBRT, stereotactic body radiation therapy; SE, standard error; TACE, transarterial chemoembolization.

Figure 1 ROC curve for the total liver volume (mL) predicting the occurrence of ≥ grade 2 hepatic adverse reactions after SBRT treatment.

Abbreviations: ROC, receiver operating characteristic; SBRT, stereotactic body radiation therapy.

Figure 2 ROC curve for the normal liver volume (mL) predicting the occurrence of ≥ grade 2 hepatic adverse reactions after SBRT treatment.

Abbreviations: ROC, receiver operating characteristic; SBRT, stereotactic body radiation therapy.