Gastrointestinal complications after radiation therapy in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: With the recent technical advancement to deliver high doses of radiation to a liver mass, radiation treatment has been increasingly used in patients with hepatocellular carcinoma. The aim of this study was to investigate the clinical characteristics of the gastrointestinal adverse effects after radiation therapy in patients with hepatocellular carcinoma.

METHODOLOGY: Between 1994 to 2002, 153 patients with hepatocellular carcinoma have been treated with radiation therapy. Medical records were systemically reviewed.

RESULTS

Upper endoscopic examinations were done in 34 patients. Radiation-induced ulcers were found in the stomach (n=9) and duodenum (n= 14). Radiation-induced gastroduodenitis was found in 9 patients. Bleeding from radiation-related lesions in 11 patients (7.2%) was caused by gastroduodenitis (n=7), gastric ulcer (n=2), and duodenal ulcer (n=2). There were 7 patients with rebleeding. Bleeding was fatal in only one patient. Two patients with obstruction were treated by stent insertion. Two patients with perforation improved after surgical repair. Hematologic toxicity was found in 53 patients (34.6%) and hepatobiliary complications were found in 40 patients (26.1%). Radiation-induced pneumonitis was found in 3 patients (2%).

CONCLUSIONS

We found that radiation-induced complications in patients with hepatocellular carcinoma are rather frequent. However, most complications were effectively managed by intensive treatments including endoscopic hemostasis, stent insertion and surgery.