Hepatic toxicity resulting from cancer treatment

• Published in: International journal of radiation oncology, biology, physics Vol. 31; no. 5; pp. 1237 - 1248
• Main Authors: Lawrence, Theodore S., Robertson, John M., Anscher, Mitchell S., Jirtle, Randy L., Ensminger, William D., Fajardo, Luis F.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 30.03.1995; Elsevier
• Subjects: Biological and medical sciences; Dose-Response Relationship, Radiation; Hepatic irradiation; Hepatic Veno-Occlusive Disease - etiology; Hepatic Veno-Occlusive Disease - pathology; Hepatitis - etiology; Hepatitis - physiopathology; Humans; Late effects; Liver - anatomy & histology; Liver - physiology; Liver - radiation effects; Liver Diseases - complications; Liver Diseases - etiology; Liver Diseases - physiopathology; Medical sciences; Radiation Injuries - complications; Radiation Injuries - physiopathology; Radiation therapy and radiosensitizing agent; Radiation Tolerance; Radiation-induced liver disease; Radiotherapy - adverse effects; Severity of Illness Index; Time Factors; Treatment with physical agents; Treatment. General aspects; Tumors; Veno-occlusive disease; Veno-occlusive disease; Late effects; Hepatic irradiation; Radiation-induced liver disease
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(94)00418-K

Radiation-induced liver disease (RILD), often called radiation hepatitis, is a syndrome characterized by the development of anicteric ascites approximately 2 weeks to 4 months after hepatic irradiation. There has been a renewed interest in hepatic irradiation because of two significant advances in cancer treatment: three dimensional radiation therapy treatment planning and bone marrow transplantation using total body irradiation. RILD resulting from liver radiation can usually be distinguished clinically from that resulting from the preparative regime associated with bone marrow transplantation. However, both syndromes demonstrate the same pathological lesion: veno-occlusive disease. Recent evidence suggests that elevated transforming growth factor β levels may play a role in the development of veno-occlusive disease. Three dimensional treatment planning offers the potential to determine the radiation dose and volume dependence of RILD, permitting the safe delivery of high doses of radiation to parts of the liver. The chief therapy for RILD is diuretics, although some advocate steroids for severe cases. The characteristics of RILD permit the development of a grading system modeled after the NCI Acute Common Toxicity Criteria, which incorporates standard criteria of hepatic dysfunction.