Is liver radiotherapy contraindicated in patients with Child-Pugh C liver function?
Would you avoid any RT in these patients, including palliation for a portal vein thrombus? Or would you consider a short course of RT (like 20Gy/5fx)?
Answer from: Radiation Oncologist at Academic Institution
I think one should be very cautious with regards to radiation for this group, whether palliative or definitive. The CPC patient has a very poor prognosis with a 2 year expected survival of only 30%. We have learned that patients with CPB liver disease, especially those with scores of 8 and above, ar...
Answer from: Radiation Oncologist at Academic Institution
I agree with Tracey totally. A recent study from Indiana University (published in PRO by Lasley and Cardenes) showed that with CPB patients, low dose spillage as low as 2.5 Gy in 5 fxs impacted on the risk of hepatic toxicity. CPC patients are expected to be worse off. That begs the question whether...
Answer from: Radiation Oncologist at Community Practice
We have an IRB approved retrospective review of patients we treated with SBRT to 50 Gy using 5 fraction SBRT with CTP C disease at OHSU. Our manuscript is currently undergoing revision and we hope to have it published sometime soon! We are hopeful these findings will advance this discuss...
Answer from: Radiation Oncologist at Community Practice
We have a very active liver SBRT program at our VA hospital, and working closely with our HCC and liver txp teams have learned to be mindful of frail patients. Child's Pugh C pts are typically dying. We need to remember that tolerance to radiotherapy, including high doses, requires a level of physio...