Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT). A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30-50 Gy (median 37.5 Gy) in 2-5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the a parts per thousand yenaEuro parts per thousand grade 2 GD toxicity were investigated. Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V-25 for stomach and V-35 for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for a parts per thousand yenaEuro parts per thousand grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V-25 a parts per thousand currency signaEuro parts per thousand 6.3 % and 57.1 % for V-25 > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V-35 a parts per thousand currency signaEuro parts per thousand 5.4 % and 45.9 % for V-35 > 5.4 %. By multivariate analysis including the clinical factors, V-25 for stomach and V-35 for duodenum were the significant factors. EGD revealed that GD toxicity is common following RT for HCC. V-25 for the stomach and V-35 for the duodenum were the significant factors to predict a parts per thousand yenaEuro parts per thousand grade 2 GD toxicity.