Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma

Purpose The aim of this work was to determine predictive factors for gastroduodenal (GD) toxicity in hepatocellular carcinoma (HCC) patients who were treated with radiotherapy (RT). Patients and methods A total of 90 HCC patients who underwent esophagogastroduodenoscopy (EGD) before and after RT were enrolled. RT was delivered as 30–50 Gy (median 37.5 Gy) in 2–5 Gy (median 3.5 Gy) per fraction. All endoscopic findings were reviewed and GD toxicities related to RT were graded by the Common Toxicity Criteria for Adverse Events, version 3.0. The predictive factors for the ≥ grade 2 GD toxicity were investigated. Results Endoscopic findings showed erosive gastritis in 14 patients (16 %), gastric ulcers in 8 patients (9 %), erosive duodenitis in 15 patients (17 %), and duodenal ulcers in 14 patients (16 %). Grade 2 toxicity developed in 19 patients (21 %) and grade 3 toxicity developed in 8 patients (9 %). V 25 for stomach and V 35 for duodenum (volume receiving a RT dose of more than x Gy) were the most predictive factors for ≥ grade 2 toxicity. The gastric toxicity rate at 6 months was 2.9 % for V 25 ≤ 6.3 % and 57.1 % for V 25 > 6.3 %. The duodenal toxicity rate at 6 months was 9.4 % for V 35 ≤ 5.4 % and 45.9 % for V 35 > 5.4 %. By multivariate analysis including the clinical factors, V 25 for stomach and V 35 for duodenum were the significant factors. Conclusion EGD revealed that GD toxicity is common following RT for HCC. V 25 for the stomach and V 35 for the duodenum were the significant factors to predict ≥ grade 2 GD toxicity.