Radiation induced liver disease: A clinical update

Benson, Rony; Madan, Renu; Kilambi, Ragini; Chander, Subhash

doi:10.1016/j.jnci.2015.08.001

Cited by 88 publications

(89 citation statements)

References 31 publications

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“…The comprehensive term RILD includes conditions such as the different degrees of liver damage after veno-occlusive changes caused by whole or partial liver irradiation, although diagnostic criteria vary [2,3]. Recent reports propose the separation of RILD into "classical" and "nonclassical" forms (Table 1) [4,7,8].…”

Section: The Clinical Features Of Radiation-induced Liver Diseasementioning

confidence: 99%

“…The onset of classical RILD occurs 2-12 weeks after radiation therapy and appears after the whole-liver tolerance considered the most sensitive serum marker [9]. Patients with classical RILD progress to a chronic stage (liver fibrosis and failure) veno-occlusive disease (VOD) caused by radiation after 3-5 months [2,8,10].…”

Section: The Clinical Features Of Radiation-induced Liver Diseasementioning

confidence: 99%

“…In the subacute phase, obstruction of sublobular veins is superimposed upon the acutephase findings. In the chronic phase, moderate elastosis in the walls of the central veins and mild elastosis in the walls of perivenular sinusoids cause occlusion of the central veins because of fibrosis, lobular collapse and distortion, and accumulation of Kupffer cells, occasionally with deposition of hemosiderin [2,3,5,6].…”

Section: The Pathological Changes In Irradiated Livermentioning

confidence: 99%

“…Radiation-induced hepatitis is described as "radiation hepatitis", "radiation-induced hepatic toxicity", "radiation-induced liver damage", and "radiation-induced liver disease (RILD)". RILD, which describes clinical and pathological features [1][2][3][4], refers to the severity of liver toxicity after high-dose radiotherapy delivered to large liver volumes or when the whole-liver tolerance dose (30)(31)(32)(33)(34)(35) is exceeded during external beam radiotherapy (RT).…”

Section: Introductionmentioning

confidence: 99%

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Pathology and images of radiation-induced hepatitis: a review article

et al. 2018

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Recent advances in highly conformal radiotherapies greatly extend the indications for radiotherapy of liver tumors. However, because of poor tolerance to hepatic radiation, estimation of the intensity of irradiation of the liver is important, particularly for a cirrhotic liver. Knowledge of radiation-induced hepatitis is important for understanding how to optimize hepatic radiation therapy. Pathological changes of the irradiated liver, which include perivenular fibrosis, sinusoidal obstruction, and damage to Kupffer cells and hepatocytes, can be visualized using clinical imaging techniques. This review article discusses and illustrates the pathological and radiological changes of hepatic tumors and the surrounding parenchyma of the irradiated liver.

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Section: The Clinical Features Of Radiation-induced Liver Diseasementioning

confidence: 99%

Section: The Clinical Features Of Radiation-induced Liver Diseasementioning

confidence: 99%

Section: The Pathological Changes In Irradiated Livermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathology and images of radiation-induced hepatitis: a review article

et al. 2018

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“…However, radiation‐induced liver disease (RILD) is one of the most severe radiation‐related complications for patients who undergo hepatic RT, which prevents radiation dose escalation and re‐irradiation for hepatobiliary malignancies 3. RILD typically occurs 4–8 weeks after RT completion, its clinical characteristics are manifested grossly as nonmalignant ascites, upper gastrointestinal hemorrhage, and veno‐occlusive, which resemble Budd–Chiari syndrome, and RILD is almost fatal since there is no effective treatment at present 4.…”

Section: Introductionmentioning

confidence: 99%

Investigation of dosimetric variations of liver radiotherapy using deformable registration of planning CT and cone‐beam CT

Huang

Chen

et al. 2016

J Applied Clin Med Phys

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Many patients with technically unresectable or medically inoperable hepatocellular carcinoma (HCC) had hepatic anatomy variations as a result of interfraction deformation during fractionated radiotherapy. We conducted this retrospective study to investigate interfractional normal liver dosimetric consequences via reconstructing weekly dose in HCC patients. Twenty‐three patients with HCC received conventional fractionated three‐dimensional conformal radiation therapy (3DCRT) were enrolled in this retrospective investigation. Among them, seven patients had been diagnosed of radiation‐induced liver disease (RILD) and the other 16 patients had good prognosis after treatment course. The cone‐beam CT (CBCT) scans were acquired once weekly for each patient throughout the treatment, deformable image registration (DIR) of planning CT (pCT) and CBCT was performed to acquire modified CBCT (mCBCT), and the structural contours were propagated by the DIR. The same plan was applied to mCBCT to perform dose calculation. Weekly dose distribution was displayed on the pCT dose space and compared using dose difference, target coverage, and dose volume histograms. Statistical analysis was performed to identify the significant dosimetric variations. Among the 23 patients, the three weekly normal liver D50 increased by 0.2 Gy, 4.2 Gy, and 4.7 Gy, respectively, for patients with RILD, and 1.0 Gy, 2.7 Gy, and 3.1 Gy, respectively, for patients without RILD. Mean dose to the normal liver (Dmean) increased by 0.5 Gy, 2.6 Gy, and 4.0 Gy, respectively, for patients with RILD, and 0.4 Gy, 3.1 Gy, and 3.4 Gy, respectively, for patients without RILD. Regarding patients with RILD, the average values of the third weekly D50 and Dmean were both over hepatic radiation tolerance, while the values of patients without RILD were below. The dosimetric consequence showed that the liver dose between patients with and without RILD were different relative to the planned dose, and the RILD patients suffered from liver dose over hepatic radiation tolerance. Evaluation of routinely acquired CBCT images during radiation therapy provides biological information on the organs at risk, and dose estimation based on mCBCT could potentially form the basis for personalized response adaptive therapy.

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Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer

Tanaka

Komatsu

Kido

et al. 2021

Annals of Gastroent Surgery

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Aim With the increased use of particle therapy for liver cancer, local recurrence after particle therapy increased. Salvage hepatectomy is an acceptable treatment option for local recurrence following particle therapy; however, its safety and effectiveness remain unclear. Therefore, this multi‐center study aimed to verify the feasibility and efficacy of salvage hepatectomy and assess clinical issues associated with its application. Methods We retrospectively assessed the perioperative outcomes, prognosis, and pathological characteristics of 15 patients who underwent salvage hepatectomy for local recurrence after particle therapy between 2006 and 2019. Results Hepatocellular carcinoma and metastatic liver tumors were noted in eight and seven patients, respectively. The mean total dose and number of fractions were 66.5 Gy and 12, respectively, and the mean interval between particle therapy and surgery was 30.1 months. Major hepatectomy was performed in seven cases. Moreover, the mortality rate was 0%, and surgical complications of Clavien‐Dindo grade IIIa or higher were observed in four cases (27%)—two bile leakages, one pleural effusion, and one refractory skin fistula. The median overall survival time and 5‐year overall survival rate after salvage hepatectomy were 29.9 months and 43.1%, respectively. Histological examination of the irradiated liver tissue surrounding the tumor showed sinusoidal dilatation, loss of hepatocyte, and fibrosis in most cases. Conclusion Salvage hepatectomy after particle therapy is a feasible therapy; however, the risk of refractory complications associated with particle therapy is relatively high. Therefore, the first‐line treatment for resectable liver cancer should be carefully determined considering second‐line treatment after local recurrence.

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Radiation induced liver disease: A clinical update

Cited by 88 publications

References 31 publications

Pathology and images of radiation-induced hepatitis: a review article

Pathology and images of radiation-induced hepatitis: a review article

Investigation of dosimetric variations of liver radiotherapy using deformable registration of planning CT and cone‐beam CT

Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer

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