Impact of right-sided breast cancer adjuvant radiotherapy on the liver

Characteristics
Age, years	Mean ± SD (min-max)
	52.53± 9.38 (32–68)
	N(%)
Smoking
No	10 (29.4)
Yes	24 (70.6)
Alcohol
No	34 (100)
NAC
Yes	15(44.1)
No	19(55.9)
Surgery
BCS	21(61.8)
MRM	13(38.2)
Stage
1A	10(29.4)
2A	14(41.2)
2B	3(8.8)
3A	7(20.6)
Histopathological
IDC	31(91.2)
ILC	1(2.9)
IMC	1(2.9)
ITC	1(2.9)

[i] BCS = breast-conserving surgery; IDC = invasive ductal carcinoma; ILC = invasive lobular carcinoma; IMC = invasive medullar carcinoma; ITC = invasive tubuler carcinoma; MRM = modified radical mastectomy; NAC = neoadjuvant chemotherapy; RT = radiotherapy

TABLE 2.

Dosimetric date

Characteristics	Value (range)
RT dose (Gy)	60.0 (50–67)
PTV volume (cc)	1063.35 (372.6–2389.6)
PTV max (cGy)	6282.4 (5323.8–7050.9)
Liver volüme (cc)	1436.1 (843.8–2298.1)
Liver V30Gy (%)	1.7 (0–12.03)
Liver mean (cGy)	759.6 (133.8–1699.8)

[i] RT = radiotherapy; PTV = planing target volume

TABLE 3.

Comparison of before and after radiotherapy (RT) blood parameters

	Before RT		After RT		Test statistics	p-value
	Mean ± SD	Median (min - max)	Mean ± SD	Median (min - max)	Test statistics	p-value
ALP	79.44 ± 34.28	71,5 (33–202)	90.5 ± 53.19	82.0 (39–357)	Z = −2.232	0.026
ALT	24.84 ± 12.95	21.0 (8–62)	20.26 ± 1.,89	17.0 (8–63)	Z = −2.423	0.015
AST	23.21 ± 7.88	21.0 (13–48)	24.32 ± 12.51	21.0 (13–74)	Z = −0.089	0.929
GGT	35.42 ± 34.08	23.0 (7–160)	33.56 ± 30.68	24.0 (12–170)	Z = −0.241	0.809
LDH	228.14 ± 64.71	224.5 (108–401)	216.85 ± 45.95	210.5 (140–310)	t = 0.968	0.340
Total protein	71.15 ± 4.88	71.0 (51–80)	72.94 ± 3.25	72.65 (64.8–79)	Z = −2.082	0.037
Albumin	41.91 ± 2.21	42.0 (38–45)	43.36 ± 2.87	43.05 (35.6–48.7)	t = −3.12	0.004
Total bilirubin	0.52 ± 0.26	0.48 (0.11–1.3)	0.51 ± 0.29	0.46 (0.19–1.9)	Z= −0.128	0.898

[i] ALP = alkaline phosphatase; ALT = alanine transaminase; AST = aspartate transaminase; GGT = gamma gulutamil transpeptida; LDH = lactat dehidrogenes; Z = Wilcoxon Tes; t = Paired Two Sample t Test

A 46-year-old female patient with a history of breast cancer and undergoing with breast-conserving surgery (BCS). **(A)** Liver distribution of radiotherapy (RT) dose (1000cGy) applied to breast; **(B)** T2 Weighted image; **(C)** Segment-2; **(D)** Segment-4A; **(E)** Segment-8; **(F)** Liver MR elastography examination from Segment-7 Elastogram measurements obtained during. When drawing the OAR, non-parenchymal structures (i.e., large vessels, bile ducts, gallbladder) that would affect the measurement were avoided. The color elastogram with a scale of 0–8 kPa shows the stiffness distribution in organs for qualitative evaluation. Orange or red regions have higher hardness values, and blue and purple regions have lower hardness values. Measured as segment-2 (3.06 Kpa), segment-4A (2.709 kPA), segment-8 (1.834 kPA), segment-7 (2.825 kPA). In the measurement made from liver segment-2, Stage 1–2 fibrosis was found. Segment-7 was normal or compatible with chronic inflammation, and the other segments were normal.

A 46-year-old female patient with a history of breast cancer who underwent modified radical mastectomy(MRM). **(A)** Liver distribution of RT dose (1000cGy) applied to chest wall location; **(B)** T2 Weighted image; **(C)** Segment-2; **(D)** Segment-4A; **(E)** Segment-8; **(F)** Liver MRE examination from segment-7 Elastogram measurements obtained during. When drawing the OAR, nonparenchymal structures (i.e., large vessels, bile ducts, gallbladder) that would affect the measurement were avoided. The color elastogram with a scale of 0–8 kPa shows the stiffness distribution in organs for qualitative evaluation. Orange or red regions have higher hardness values, and blue and purple regions have lower hardness values. Measured as segment-2 (3.44 Kpa), segment-4A (3.219 kPA), segment-8 (5.930 kPA), segment-7 (3.449 kPA). The measurement made from liver segment-2,-4A,-7 was found to be compatible with Stage 1–2 fibrosis, and the measurement from segment-8 was found to be compatible withs Stage 4 fibrosis.

TABLE 4.

Distribution of kPa values in liver segments and stages (distribution of each response)

Segment (Grade)	n(%)
Segment-2
1	13 (38.2)
2	14 (41.1)
3	1 (2.9)
N	6 (17.6)
N~ or Chronic Inflammation	14 (41.1)
Segment 4a
1	13 (38.2)
2	20 (58.8)
3	11 (32.3)
4	2 (5.8)
N	6 (17.6)
N~ or Chronic Inflammation	3 (8.8)
Segment 8
1	9 (26.4)
2	14 (41.1)
3	12 (35.2)
4	7 (20.5)
N	4 (11.7)
N~ or Chronic Inflammation	4 (11.7)
Segment 7
1	2 (5.8)
2	2 (5.8)
N	19 (55.8)
N~ or Chronic Inflammation	13 (38.2)
Segment 3
1	4 (11.7)
2	4 (11.7)
N	16 (47.0)
N~ or Chronic Inflammation	14 (41.1)
Segment 4b
1	8 (23.5)
2	9 (26.4)
3	1 (2.9)
N	17 (50.0)
N~ or Chronic Inflammation	8 (23.5)
Segment 5
1	7 (20.5)
2	7 (20.5)
N	15 (44.1)
N~ or Chronic Inflammation	12 (35.2)
Segment 6
1	1 (2.9)
2	1 (2.9)
N	19 (55.8)
N~ or Chronic Inflammation	14 (41.1)

[i] N = normal

TABLE 5.

Relationship between kPa values and liver volume in liver segments

Liver segments (kPA values)	Liver volüme (cc)	Liver V 30Gy	Liver mean (Gy)
Segment 2	r = 0.109; p = 0.539	r = 0.089; p = 0.616	r = 0.171; p = 0.332
Segment 4A	r = 0.239; p = 0.173*	r = 0.088; p = 0.619	r = −0.014; p = 0.938*
Segment 8	r = 0.107; p = 0.548*	r = −0.043; p = 0.809	r = −0.144; p = 0.417*
Segment 7	r = 0.266; p = 0.129	r = −0.139; p = 0.432	r = −0.115; p = 0.517
Segment 3	r = −0.068; p = 0.701*	r = −0.057; p = 0.749	r = −0.188; p = 0.286*
Segment 4B	r = 0.284; p = 0.103*	r = 0.224; p = 0.203	r = 0.186; p = 0.293*
Segment 5	r = 0.355; p = 0.039	r = −0.074; p = 0.679	r = −0.074; p = 0.677
Segment 6	r = 0.062; p = 0.729*	r = 0.073; p = 0.683	r = 0.017; p = 0.926*

[i] R = Spearman’s rho Correlation Coefficient;

[ii] r* = Pearson Correlation Coefficient

TABLE 6.

Relationship between after-RT segment values and liver RT dose and biochemical variables

	Segment 2	Segment 4A	Segment 8	Segment 7	Segment 3	Segment 4B	Segment 5	Segment 6
Liver Volüm	r=0,109; p=0.539	r=0.239; p=0.173*	r=0.107; p=0.548*	r=0.266; p=0.129	r=−0.068; p=0.701*	r=0.284; p=0.103*	r=0.355; p=0.039	r=0,062; p=0,729*
Lıver V 30Gy	r=0,089;p=0.616	r=0,088; p=0,619	r=−0,043; p=0,809	r=−0,139; p=0,432	r=−0,057; p=0,749	r=0,224; p=0,203	r=−0,074; p=0,679	r=0,073; p=0,683
ALP	r=0,102;p=0.565	r=0,398; p=0,020	r=0,175; p=0,323	r=0,298; p=0,087	r=0,149; p=0,401	r=0,227; p=0,198	r=0,002; p=0,993	r=0,500; p=0,003
ALT	r=0,145;p=0.413	r=0,165; p=0,351	r=0,246; p=0,16	r=0,259; p=0,139	r=0,172; p=0,331	r=0,163; p=0,357	r=0,107; p=0,546	r=0,294; p=0,092
T.PRO	r=−0,129; p=0,469	r=0,1; p=0,575*	r=−0,37; p=0,031*	r=−0,148; p=0,404	r=0,145; p=0,412*	r=0,016; p=0,929*	r=0,041; p=0,818	r=0,17; p=0,337*
ALB	r=0,026; p=0,882	r=0,235; p=0,18*	r=−0,113; p=0,526*	r=0,11; p=0,535	r=0,036; p=0,839*	r=0,227; p=0,196*	r=0,013; p=0,943	r=0,074; p=0,679*

[i] ALB = albumin; ALP = alkaline phosphatase; ALT = alanine transaminase; T.PRO = total proteine; r = Spearman’s rho Korelasyon Katsayısı;

[ii] r* = Pearson Korelasyon Katsayısı

TABLE 7.

Comparison of liver values according to surgery

BCS		MRM
Mean ± SD	Median (min-max)	Mean ± SD	Median (min-max)
Liver Volume (cc)	1552.46 ± 320.52	1566.6 (1014–2123.5)	1408.3 ± 361.23	1290. (843.8–2298.1)	t = 1.214	0.233
Liver V 30Gy (%)	3.1 ± 3.03	1.9 (0–9.1)	2.8 ± 3.93	1.4 (0–12.03)	U = 111.5	0.381
Liver mean (Gy)	765.46 ± 339.81	756.7 (257.2–1564.2)	729.81 ± 451.29	762.5 (133.8–1699.8)	t = 0.262	0.795

[i] BCS = breast conserving surgery; MRM = modified radical mastectomy; T = Independent Samples t Test; U = Mann-Whitney U-test

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DOI: https://doi.org/10.2478/raon-2024-0059 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 535 - 543

Submitted on: Aug 6, 2024

Accepted on: Sep 17, 2024

Published on: Nov 28, 2024

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

radiotherapy,

right-sided breast cancer,

magnetic resonance elastography,

radiation-induced liver disease,

Related subjects:

© 2024 Gonca Hanedan Uslu, Filiz Taşçı, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 58 (2024): Issue 4 (December 2024)

Impact of right-sided breast cancer adjuvant radiotherapy on the liver

Figures & Tables

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