Dose-Volume Correlations for Abdominal Acute Toxicity and Acute Care Utilization Following Liver SBRT
Abstract
Purpose
Stereotactic body radiation therapy (SBRT) has been shown to be an effective treatment for hepatocellular carcinoma associated with lower rates of severe toxicity because of treatment. However, SBRT for liver carcinoma can still cause symptoms that may be associated with acute care utilization. We examine this by calculating the predictive value of SBRT dosimetric parameters for post treatment symptoms and subsequent prescription of new medications.
Methods
Liver carcinoma patients treated at UNC from 2014-2025 with definitive or palliative SBRT were included in this study. Rates of post-SBRT treatment symptoms including acute nausea and vomiting were measured by patient self-reporting. The need for anti-emetics, anxiolytics, and analgesics was assessed, controlling for baseline use. The absolute and normalized dose volume histograms (DVH) of each patient were used to calculate area under the curve (AUC) and identify statistically significant hazard ratios (HR) for the healthy liver, stomach, duodenum and GTV for the endpoints of ED visits and need for new anti-emetics.
Results
193 patients were analyzed in this study. 28 patients required new anti-emetics and 35 had ED visits. DVH analysis showed that for healthy liver V8Gy > 45% (HR = 2.0, 95% confidence interval (95%CI) = 1.0-4.0, p=0.05) and D700cc > 10Gy (HR = 2.3, 95%CI = 1.1-4.6, p=0.03) were correlated with need for anti-emetics. The best correlations for GTV and stomach were found for D144cc > 40Gy (HR = 3.6, 95%CI = 1.3-10.3, p=0.02) and D80cc > 12Gy (HR = 2.2, 95%CI = 0.5-9.0, p=0.3), respectively.
Conclusion
The dosimetric analysis revealed that liver V8 and D700cc were associated with symptoms requiring new prescription medication. The results from this study will be used to refine treatment planning guidelines to minimize the risk of acute side effects and care utilization for hepatocellular carcinoma patients receiving SBRT