Radiation-associated liver injury

Abstract

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.

Figure 1

Reference dose vs Effective Volume for 5% Isotoxicity curve for classic RILD after conformal radiation therapy, delivered in 1.5 Gy BID fractionation, for primary or metastatic tumors. Redrawn from [8]. The shaded areas around each curve represent the 80% confidence limits, which overlap above a reference dose of approximately 45 Gy.

Figure 2

Mean liver dose, corrected with LQ modeling for 2.0 Gy fractions, versus Lyman normal tissue complication probability (NTCP) of classic radiation-induced liver disease (RILD) for primary and metastatic liver cancer, redrawn from reference [24].

Figure 3

Characteristic normal liver (minus GTV) DVHs for low (A) or high (B) dose-per fraction. A. Mean normal liver DVHs from the University of Michigan for 204 patients who did or did not experience RILD. B. Mean normal liver DVHs from the University of Colorado SBRT Phase I trial with no radiation-induced liver disease (RILD) observed. See text for additional details.

Figure 3

Characteristic normal liver (minus GTV) DVHs for low (A) or high (B) dose-per fraction. A. Mean normal liver DVHs from the University of Michigan for 204 patients who did or did not experience RILD. B. Mean normal liver DVHs from the University of Colorado SBRT Phase I trial with no radiation-induced liver disease (RILD) observed. See text for additional details.