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Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys

Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor 48109, USA.
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.18). 04/1995; 31(5):1237-48. DOI: 10.1016/0360-3016(94)00418-K
Source: PubMed

ABSTRACT 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 beta 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.

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    • "External beam radiation has not found an appreciable place in the management of liver tumors because the liver is poorly tolerant of radiation therapy. Whole- Liver doses in excess of 30 Gy may cause fatal radiation hepatitis, which is characterized by the development of portal hypertension, ascites, progressive liver failure and death as a result of a Veno-occlusive-type lesion [13] [14] . Yttrium90 is a high-energy, pure â-emitter with a half-life of 64 hours and maximum tissue penetration of 11 mm, which makes it very suitable for treatment of liver tumors [15-17] . "
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    • "External beam radiation has not found an appreciable place in the management of liver tumors because the liver is poorly tolerant of radiation therapy. Whole- Liver doses in excess of 30 Gy may cause fatal radiation hepatitis, which is characterized by the development of portal hypertension, ascites, progressive liver failure and death as a result of a Veno-occlusive-type lesion [13] [14] . Yttrium90 is a high-energy, pure â-emitter with a half-life of 64 hours and maximum tissue penetration of 11 mm, which makes it very suitable for treatment of liver tumors [15-17] . "
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    ABSTRACT: The paper has reviewed the use of Selective Internal Radiation Therapy (SIRT) using SIR-Spheres, which is a therapeutic 'device' for the treat-ment of non-resectable hepatic metastases secondary to colorectal can-cer in the absence of extrahepatic metastases. SIRT involves a single de-livery of Yttrium 90 micro-spheres in the hepatic artery. Preferential uptake is achieved into liver tumors, because of their predominant hepatic arterial blood supply. The treatment is well tolerated and has been documented internationally to achieve response rates of around 90% in patients with extensive colorectal cancer (CRC) liver metastases. The product obtained FDA approval in the USA in 2002. Unlike other ablative therapies being applied to non-resectable liver tumors, SIRT is indicated even in patients with an extensive burden of liver tumor. Indications, dosing schedules and expected outcomes will be better defined.  2013 Trade Science Inc. -INDIA INTRODUCTION [1-12]
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    • "There are scores of chemotherapeutic agents in current use and under study, and many of them are used in combinations, making detailed consideration of each agent not only complex but also lengthy and beyond what can be included in this discussion (for more detailed discussion of individual chemotherapeutic agents, the reader is referred to the excellent reviews of Alden, Lin, and Smith 2003; Eklund et al. 2005; Floyd et al. 2006; Field, Dow, and Michael 2008; King and Perry 1995; and Lawrence et al. 1995). Unfortunately, we do not fully understand the mechanisms by which chemotherapeutic agents may cause injury to liver cells in susceptible patients. "
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    ABSTRACT: Chemotherapy is meant to be toxic, but it is particularly aimed at the tumor cells. Collateral damage may occur to normal cells and tissues, especially if they are fairly rapidly regenerating, as is the case for bone marrow cells, intestinal epithelial cells, and liver cells after hepatic injury. The liver has a great capacity to resist injury, overcome it, and to regenerate, even after quite massive injury (resection of 50%-65%, for example). This capacity may make it susceptible to chemotherapeutic toxicity, and a struggle between injury and adaptation, leading to recovery and tolerance or to failure and death. If the chemotherapy is aimed just at delaying progression of the cancer for a few weeks or months, it may not be worth the risk of irreversible liver injury developing in that time. Close clinical observation and sound clinical judgment are required.
    Toxicologic Pathology 10/2009; 38(1):142-7. DOI:10.1177/0192623309351719 · 1.92 Impact Factor
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