HEPATIC TOXICITY RESULTING FROM CANCER-TREATMENT

Radiation-induced liver disease (RILD), often called radiation hepatit is, is a syndrome characterized by the development of anicteric ascite s approximately 2 weeks to 4 months after hepatic irradiation. There h as been a renewed interest in hepatic irradiation because of two signi ficant advances in cancer treatment: three dimensional radiation thera py treatment planning and bane marrow transplantation using total body irradiation. RILD resulting from liver radiation can usually be disti nguished clinically from that resulting from the preparative regime as sociated with bone marrow transplantation. However, both syndromes dem onstrate 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 d imensional treatment planning offers the potential to determine the ra diation dose and volume dependence of RILD, permitting the safe delive ry of high doses of radiation to parts of the liver. The chief therapy for RILD is diuretics, although some advocate steroids for severe cas es. The characteristics of RILD permit the development of a grading sy stem modeled after the NCI Acute Common Toxicity Criteria, which incor porates standard criteria of hepatic dysfunction.