Liver

Abstract

The hepatic toxicity related to radiation therapy is classic radiation-induced liver disease (RILD) which presents within 3 months following radiation therapy with anicteric ascites and hepatosplenomegaly, characterized with central and sublobular hepatic vein occlusive lesions, with sparing of the periportal areas, larger hepatic veins, and hepatic arterial vasculature. No established standard exists. In 2 Gy per fraction, the mean liver doses estimated to be associated with a 5 % risk of classic RILD for primary and metastatic liver cancer are 28 and 32 Gy. Other non-classic RILD radiation hepatic toxicities include hepatitis and a general decline in liver function that may be precipitated by radiation therapy. TGF-β has been implicated in playing a role in the fibrogenesis leading up to RILD. Irradiation of rat liver in vivo induces upregulation of proinflammatory cytokines IL-1-beta, IL-6, and tumor necrosis factor alpha (Christiansen et al. in Radiology 242:189–197, ). Changes in CT and MRI contrast enhancement have been seen within regions of the liver (Herfarth et al. in Int J Radiat Oncol Biol Phys 57:444–451, ). Veno-occlusive disease (VOD) is a frequent, serious, and often life threatening complication of hematopoietic stem cell or bone marrow transplantation. Patterns of chemotherapy liver toxicity include: hepatitis, cholestasis, steatosis, fibrosis, and vascular lesions. Hepatic toxicity related to chemotherapy is usually idiosyncratic, unpredictable, and not dose-related. Direct hepatocellular injury from chemotherapy is less common and predictable. Baseline liver function tests and imaging, with serial re-evaluation, can aid in determining the cause of deteriorating liver function which may be related to underlying liver dysfunction, reactivation of a dormant virus, drug, or the cancer itself.