Hepatic dysfunction after radiotherapy for primary gastric lymphoma

Patients with primary gastric lymphoma (pgl) are often treated with three-dimensional conformal radiotherapy (3d-crt) in three to four fields to reduce the dose to the left kidney. however,the liver dose is higher than conventional parallel-opposed fields. this study was designed to evaluate hepatic dysfunction after 3d-crt in patients with pgl. the data of 20 pgl patients treated with 3d-crt were analyzed. of the 20 patients,3 had mucosa-associated lymphoid tissue (malt) lymphoma and 17 had diffuse large b-cell lymphoma (dlbcl). the median dose used to treat malt lymphoma was 30 gy and 40 gy for dlbcl. pretreatment and post-treatment transaminase and alkaline phosphatase (alp) values were compared. radiation-induced hepatic dysfunction (rihd) was defined as a more than 2-fold increase in transaminase or alp levels,exceeding the upper limit within 4 months of the completion of radiotherapy. increased transaminase or alp levels were observed in 19 patients (95%). rihd was observed in 14 patients (70%). the transaminase and alp values were significantly different between pretreatment and post-treatment. there were significant differences in liver volumes receiving ≥5,≥10,≥15 and ≥20 gy (v5,v10,v15 and v20) and in the mean liver doses between patients with and without rihd. for patients with v10 > 60%,v15 > 50% or v20 > 30% in particular,the incidence rates of rihd were significantly high. after radiotherapy for pgl,hepatic dysfunction occurred at a high rate. thus,radiotherapy treatment should be planned in order to reduce liver doses. © the author 2012. published by oxford university press on behalf of the japan radiation research society and japanese society for therapeutic radiology and oncology.