{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:18:51Z","timestamp":1787840331172,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n This study observed the clinical outcome of radiotherapy to extensive intrahepatic targets for advanced hepatocellular carcinoma (HCC) in a single institution.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n From September 2009 to July 2021, patients who underwent fractionated radiotherapy to a planning target volume (PTV) of over 100 ml with biological effective dose >30 Gy\n 10<\/jats:sub>\n for advanced HCC were enrolled. Overall survival (OS) and radiation-induced liver toxicity (RILD) were evaluated. RILD was defined as an increase in Child-Pugh (CP) score \u22652 or liver function tests \u22652.5 times at 3 months after the end of radiotherapy.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 136 patients were evaluated. Eighty-nine patients had portal vein tumor thrombus (PVTT), 37 patients were in CP B stage, and the median radiation dose to PTV was 48.8 Gy\n 10<\/jats:sub>\n . The median OS was 12.3 months. The factors most affecting OS were PVTT (\n P<\/jats:italic>\n = 0.001), PTV (>500 ml,\n P<\/jats:italic>\n = 0.001), incomplete coverage of the intrahepatic tumor (\n P<\/jats:italic>\n = 0.004), and CP B (\n P<\/jats:italic>\n = 0.006) in Cox regression. RILD occurred in 22.4% of the patients and was affected by PVTT (\n P<\/jats:italic>\n = 0.003), PTV (\n P<\/jats:italic>\n = 0.010), pretreatment bilirubin levels (>1.5 mg\/ml,\n P<\/jats:italic>\n = 0.016), and the mean normal liver dose (MNLD) (\u2265 EQD\n 2<\/jats:sub>\n 18 Gy\n 3<\/jats:sub>\n ,\n P<\/jats:italic>\n = 0.021) in binary logistic regression. As the PTV was in excess of >500 ml, RILD developed in 30.2% of patients and the prognostic importance of pretreatment bilirubin levels (\n P<\/jats:italic>\n = 0.006) and the MNLD (\n P<\/jats:italic>\n = 0.014) increased.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n As PTV is more extensive, the bilirubin level and the MNLD have to be taken into consideration for safe radiotherapy, in addition to the traditional prognostic factors.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/sjg.sjg_195_24","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T03:00:44Z","timestamp":1725073244000},"page":"399-406","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes and safety of external beam radiotherapy with extensive intrahepatic targets for advanced hepatocellular carcinoma: A single institutional clinical experience"],"prefix":"10.4103","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-9529","authenticated-orcid":false,"given":"Sunmin","family":"Park","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7431-4588","authenticated-orcid":false,"given":"Chai Hong","family":"Rim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6098-1993","authenticated-orcid":false,"given":"Won Sup","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of 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