The liver is a critically important organ that has numerous functions including the production of bile, metabolism of ingested nutrients, elimination of many waste products, glycogen storage, and plasma protein synthesis. The liver is often incidentally irradiated during radiation therapy (RT) for tumors in the upper- abdomen, right lower lung, distal esophagus, or during whole abdomen or whole body RT. This article describes the endpoints, time-course, and dose-volume effect of radiation on the liver.

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A review of literature on the development of sensorineural hearing loss after high-dose radiation therapy for head-and-neck tumors and stereotactic radiosurgery or fractionated stereotactic radiotherapy for the treatment of vestibular schwannoma is presented. Because of the small volume of the cochlea a dose-volume analysis is not feasible. Instead, the current literature on the effect of the mean dose received by the cochlea and other treatment-and patient-related factors on outcome are evaluated. Based on the data, a specific threshold dose to cochlea for sensorineural hearing loss cannot be determined; therefore, dose-prescription limits are suggested. A standard for evaluating radiation therapy-associated ototoxicity as well as a detailed approach for scoring toxicity is presented. KeywordsRadiotherapy; Sensorineural hearing loss; Ototoxicity; Auditory; Ear; QUANTEC CLINICAL SIGNIFICANCERadiation therapy (RT) may damage the cochlea and/or acoustic nerve, leading to sensorineural hearing loss (SNHL) (1-4), with resultant long-lasting compromise in the quality of life. This report focuses on RT-induced SNHL in adults who have received fractionated RT, stereotactic radiosurgery (SRS), and fractionated stereotactic RT (FSRT) for head-and-neck cancers and vestibular schwannomas (VS). ENDPOINTSSNHL is traditionally defined as a clinically significant increase in bone conduction threshold (BCT) at the key human speech frequencies (0.5-4.0 kHz), as seen in pure-tone audiometry. However, reports of SNHL after fractionated RT vary in terms of: (a) the frequencies evaluated (e.g., 2 or 4 kHz alone (5,6) and/or pure tone average [PTA] of

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