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Gastroduodenal complications after concurrent chemoradiation therapy in patients with hepatocellular carcinoma: endoscopic findings and risk factors

Authors
 Young Eun Chon  ;  Jinsil Seong  ;  Beom Kyung Kim  ;  Jihye Cha  ;  Seung Up Kim  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Kwang-Hyub Han  ;  Chae Yoon Chon  ;  Sung Kwan Shin  ;  Do Young Kim 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.81(5) : 1343-1351, 2011 
Journal Title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN
 0360-3016 
Issue Date
2011
MeSH
Adult ; Antimetabolites, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/therapy* ; Chemoradiotherapy/adverse effects* ; Chemoradiotherapy/methods ; Duodenal Ulcer/diagnosis ; Duodenal Ulcer/epidemiology ; Duodenitis/diagnosis ; Duodenitis/epidemiology ; Duodenum/radiation effects* ; Endoscopy, Gastrointestinal* ; Female ; Fluorouracil/administration & dosage ; Gastritis/diagnosis ; Gastritis/epidemiology ; Gastrointestinal Hemorrhage/etiology ; Humans ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Nausea/epidemiology ; Nausea/etiology ; Prevalence ; Prospective Studies ; Radiation Injuries/diagnosis* ; Radiation Injuries/epidemiology ; Radiotherapy Dosage ; Risk Factors ; Stomach/radiation effects* ; Stomach Ulcer/diagnosis ; Stomach Ulcer/epidemiology ; Vomiting/epidemiology ; Vomiting/etiology
Keywords
Hepatocellular carcinoma ; Radiotherapy ; Concurrent chemoradiation therapy ; Endoscopy ; Complication
Abstract
PURPOSE: Concurrent chemoradiation therapy (CCRT) is useful in advanced hepatocellular carcinoma (HCC), but little is known about radiation-induced gastroduodenal complications following therapy. To determine risk factors, we investigated the prevalence and patterns of gastroduodenal complications following CCRT using endoscopy.

METHODS AND MATERIALS: Enrolled in the study were 123 patients treated with CCRT for unresectable HCC between January 1998 and December 2005. Radiation-induced gastroduodenal complications were defined as radiation gastritis/duodenitis, radiation gastric/duodenal ulcer, or other gastroduodenal toxicity associated with radiation, based on Common Terminology Criteria for Adverse Events (CTCAE 3.0). Serious gastroduodenal complications were defined as events occurring within 12 months from completion of CCRT, those requiring prompt therapeutic intervention, or symptoms equivalent to Grade 3 or 4 radiation-related gastroduodenal toxicity, including nausea or vomiting, based on CTCAE 3.0.

RESULTS: A month after completion of CCRT, 65 (52.8%) patients displayed endoscopic evidence of radiation-induced gastroduodenal complications. Radiation gastric and duodenal ulcers were found in 32 (26.0%) and 20 (16.3%) patients, respectively; radiation gastritis and duodenitis were found in 50 (40.7%) and 42 (34.1%) patients, respectively. Radiation-related bleeding was observed in 13 patients (10.6%). Serious gastroduodenal complications occurred in 18 patients (14.6%) and were significantly more frequent in patients with liver cirrhosis than in those without cirrhosis (p=0.043). There were no radiation-related deaths.

CONCLUSIONS: Endoscopically detectable radiation-induced gastroduodenal complications were common in HCC following CCRT. Although serious complications were uncommon, the frequency was higher in patients with liver cirrhosis; thus, these patients should be closely monitored when receiving CCRT.
Full Text
http://www.sciencedirect.com/science/article/pii/S0360301610030336
DOI
10.1016/j.ijrobp.2010.07.1986
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Chon, Young Eun(전영은)
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94486
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