HEMATOLOGICAL & BIOCHEMICAL CHANGES DURING AND POST SBRT FOR HCC : AN INSTITUTIONAL STUDY
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Abstract
HEMATOLOGICAL & BIOCHEMICAL CHANGES DURING AND POST SBRT FOR HCC : AN INSTITUTIONAL STUDY
Authors: SHIPRA GUPTA1, H.P. Yadav2, S.K. Sarin3, Anil Gupta4, Rishabh Sahansi4, Rose Kamal5, Deepak Thaper6
1All India Institute of Medical Sciences, New Delhi, National Cancer Institute, Radiation Oncology, New Delhi, India; 2Institute of Liver & Biliary Sciences, New Delhi, Radiation Oncology, New Delhi, India; 3Institute of Liver & Biliary Sciences, New Delhi, Hepatology, New Delhi, India; 4All India Institute of Medical Sciences, New Delhi, Radiation Oncology, New Delhi, India; 5Institute of Liver & Biliary Sciences , Radaition Oncology, New Delhi, India; 6Institute of Liver & Biliary Sciences , Radiation Oncology, New Delhi, India
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Purpose or Objective
To study the hematological and biochemical parameters over the course of SBRT treatment. And to establish its clinical and dosimetric correlations.
Material and Methods
A total of 27 patients with unresectable and nonmetastatic HCC were treated with stereotactic body radiotherapy (SBRT). Triple phase 4DCT was done for simulation and contouring was done with the generation of internal target volume. Complete blood counts, liver functions and tumor markers, namely Alpha feto protein (AFP) & Protein induced by vitamin K absence-II (PIVKAII) were collected at baselines, during 1st and 2nd week of SBRT, at 1 month and at 3 months of treatment. The dose-volume effect of Spleen was correlated with thrombocytopenia and leukopenia. Students T test and the bivariate correlation analysis was used for the statistical analysis. Confidence interval was set to 95% and p value was set to be significant at <0.05.
Results
A total of 14 and 13 patients had child pugh A and B, respectively. The mean dose per fraction delivered was 7.6Gy (3-10Gy) over an average period of 2 weeks. Majority of the patients belonged to staged IV (BCLC –C). There was significant decrease in the lymphocyte count during SBRT at 1st and 2nd week as compared to baseline(p=0.001). The thrombocytopenia and packed cell volume at 2 weeks was correlated with the volume of spleen receiving more than 10 Gy of dose(V10). The mortality rate was correlated with higher mean dose to the spleen. Significant rise of neutrophil to lymphocyte ratio was seen during both the weeks of treatment. AFP and PIVKA II were collected and compared. There was an initial rising trend of AFP during 1st week of treatment which started to fall after 1 month. Levels of PIVKA II were found to fall rapidly from baseline till 2nd week of radiation. No significant changes were observed in liver functions during the radiation course. None of the patients developed radiation induced liver disease.
Conclusion
Liver SBRT is safe and is related with only moderate morbidity to the patients. Leukopenia and thrombocytopenia is observed mainly during the course of radiation, which normalizes till 1 month of treatment. AFP levels shows a rise initially and start to decrease till 1 month after radiation unlike PIVKA II which tends to fall at the commencement of radiation.