Risk Factors of Non-Classic Radiation-Induced Liver Disease (ncRILD) After Intensity-Modulated Radiotherapy in Hepatocellular Carcinoma.
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PURPOSE: This study aimed to identify independent risk factors for non-classic radiation-induced liver disease (ncRILD) in hepatocellular carcinoma (HCC) patients treated with intensity-modulated radiation therapy (IMRT) and to construct a predictive nomogram. PATIENTS AND METHODS: We retrospectively analyzed 177 primary HCC patients treated with IMRT between 2013 and 2021. Univariate and multivariate analyses were conducted to identify risk factors for ncRILD. A nomogram was developed based on significant variables. Dosimetric parameters were also assessed across different fractionation doses. RESULTS: Multivariate analysis identified tumor number ≥ 2, mean liver dose ≥ 1371.4 cGy, and normal liver volume < 700 mL as independent risk factors for ncRILD. A nomogram was established using logistic regression. In patients receiving ≥ 4 Gy per fraction, ncRILD was significantly associated with Vs5-Vs40 (p < 0.05), but not with V5-V40. No such associations were found for 2 Gy and 3 Gy groups. CONCLUSION: Patients with multifocal tumor, lower normal liver volume and higher mean liver dose are at increased risk of developing radiation-induced liver injury. These findings suggest that dosimetric parameters, especially at higher fraction doses, may play a critical role in the occurrence of ncRILD.