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

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

Radiology and Oncology
Volume 58 (2024): Issue 4 (December 2024)
By: Gonca Hanedan Uslu and  Filiz Taşçı  
Open Access
|Nov 2024

Figures & Tables

FIGURE 1.

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 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.

FIGURE 2.

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.
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.

FIGURE 3.

Patients kPa values in liver segments.
Patients kPa values in liver segments.

Dosimetric date

CharacteristicsValue (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)

Patients characteristics (N = 34)

Characteristics
Age, yearsMean ± SD (min-max)
52.53± 9.38 (32–68)
N(%)
Smoking
  No10 (29.4)
  Yes24 (70.6)
Alcohol
  No34 (100)
NAC
  Yes15(44.1)
  No19(55.9)
Surgery
  BCS21(61.8)
  MRM13(38.2)
Stage
  1A10(29.4)
  2A14(41.2)
  2B3(8.8)
  3A7(20.6)
Histopathological
  IDC31(91.2)
  ILC1(2.9)
  IMC1(2.9)
  ITC1(2.9)

Relationship between kPa values and liver volume in liver segments

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

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

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

Comparison of liver values according to surgery

Surgery
Test Statisticsp-value
BCSMRM
Mean ± SDMedian (min-max)Mean ± SDMedian (min-max)
Liver Volume (cc)1552.46 ± 320.521566.6 (1014–2123.5)1408.3 ± 361.231290. (843.8–2298.1)t = 1.2140.233
Liver V 30Gy (%)3.1 ± 3.031.9 (0–9.1)2.8 ± 3.931.4 (0–12.03)U = 111.50.381
Liver mean (Gy)765.46 ± 339.81756.7 (257.2–1564.2)729.81 ± 451.29762.5 (133.8–1699.8)t = 0.2620.795

Comparison of before and after radiotherapy (RT) blood parameters

Before RTAfter RTTest statisticsp-value
Mean ± SDMedian (min - max)Mean ± SDMedian (min - max)
ALP79.44 ± 34.2871,5 (33–202)90.5 ± 53.1982.0 (39–357)Z = −2.2320.026
ALT24.84 ± 12.9521.0 (8–62)20.26 ± 1.,8917.0 (8–63)Z = −2.4230.015
AST23.21 ± 7.8821.0 (13–48)24.32 ± 12.5121.0 (13–74)Z = −0.0890.929
GGT35.42 ± 34.0823.0 (7–160)33.56 ± 30.6824.0 (12–170)Z = −0.2410.809
LDH228.14 ± 64.71224.5 (108–401)216.85 ± 45.95210.5 (140–310)t = 0.9680.340
Total protein71.15 ± 4.8871.0 (51–80)72.94 ± 3.2572.65 (64.8–79)Z = −2.0820.037
Albumin41.91 ± 2.2142.0 (38–45)43.36 ± 2.8743.05 (35.6–48.7)t = −3.120.004
Total bilirubin0.52 ± 0.260.48 (0.11–1.3)0.51 ± 0.290.46 (0.19–1.9)Z= −0.1280.898

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

Segment (Grade)n(%)
Segment-2
  113 (38.2)
  214 (41.1)
  31 (2.9)
  N6 (17.6)
  N~ or Chronic Inflammation14 (41.1)
Segment 4a
  113 (38.2)
  220 (58.8)
  311 (32.3)
  42 (5.8)
  N6 (17.6)
  N~ or Chronic Inflammation3 (8.8)
Segment 8
  19 (26.4)
  214 (41.1)
  312 (35.2)
  47 (20.5)
  N4 (11.7)
  N~ or Chronic Inflammation4 (11.7)
Segment 7
  12 (5.8)
  22 (5.8)
  N19 (55.8)
  N~ or Chronic Inflammation13 (38.2)
Segment 3
  14 (11.7)
  24 (11.7)
  N16 (47.0)
  N~ or Chronic Inflammation14 (41.1)
Segment 4b
  18 (23.5)
  29 (26.4)
  31 (2.9)
  N17 (50.0)
  N~ or Chronic Inflammation8 (23.5)
Segment 5
  17 (20.5)
  27 (20.5)
  N15 (44.1)
  N~ or Chronic Inflammation12 (35.2)
Segment 6
  11 (2.9)
  21 (2.9)
  N19 (55.8)
  N~ or Chronic Inflammation14 (41.1)
DOI: https://doi.org/10.2478/raon-2024-0059 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
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,
liver fibrosis
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 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.

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