Child-Pugh score maintenance in cirrhotic hepatocellular carcinoma patients after radiotherapy: aspects of gastroduodenal complications

Aims and background. This study was designed to evaluate the prevalence of gastroduodenal complications and factors that contribute to the development of symptomatic GD toxicity in cirrhotic patients with perihilar hepatocellular carcinoma (HCC), after an acceptable dose of radiotherapy. Methods. This was a retrospective study of 40 cirrhotic patients with perihilar HCC treated with radiotherapy from August 2008 to September 2010. Esophagogastroduodenoscopy was performed before and after radiotherapy. The maximum point dose to the gastroduodenum was 35.8 to 44 Gy (2 Gy equivalent, alpha/beta = 10). Gastroduodenal complications were graded using the Common Terminology Criteria for Adverse Events (CTCAE; version 3.0). Child-Pugh score was assessed 3 months after completion of radiotherapy, and compared with the score obtained before radiotherapy. Results. Gastroduodenal complications were observed in 22 patients (55.0%) after radiotherapy. Twelve of these patients (30%) needed medical interventions. Although there were no significant factors that directly correlated with the prevalence of all-grade gastroduodenal complications, symptomatic complications (grade 2 or higher) were significantly related to the degree of Child-Pugh score elevation after radiotherapy (P = 0.002). Conclusions. Considerable gastroduodenal complications developed in cirrhotic patients with perihilar HCC after an acceptable dose of radiotherapy. The aspects of gastroduodenal toxicities and the maintenance of liver function after radiotherapy may be an important issue in patients who undergo this treatment.