Radiation hepatitis

Primary hepatobiliary cancer University of Michigan Radiation + hepatic arterial floxuridine 16 mo... 

Ingold J, Reed G, Kaplan H (1965) Radiation Hepatitis. Am J Roentgenol 93 200-208... 

Lawrence TS, Ten Haken RK, Kessler ML et al (1992) The use of 3-D dose volume analysis to predict radiation hepatitis. Int J Radiat Oncol Biol Phys 23 781-788... 

Van Hazel first instituted this modification during clinical trials where radiation hepatitis appeared in patients with smaller liver volumes [35]. Unfortunately there has not been a subsequent publication showing the rationale, validity or correlation between BSA, liver volume, tumor volume and radiation hepatitis. It represents a sometimes significant decrease in activity (small patient, small liver) compared to the empiric approach, and at other times, it calls for a modest increase in activity (small patient, large liver) compared to the empiric. It has been demonstrated that the empiric and BSA methods usually overestimate the activity that can be delivered to a patient [36, 37] (Fig. 6.1). 

In addition to the selective distribution of the microspheres to the liver, the distribution within the liver plays a critical role. It should result in low radiation doses to normal liver tissue and a lethal dose (typically more than 120 Gy) to the tumor tissue. Abnormal high radiation doses to normal tissue may result in radiation induced hepatitis with potential risk of liver failure. It is believed that mild radiation hepatitis is more common than initially assumed as some of its indicators including increased splenic and diminished normal liver volumes (suggesting mild portal hypertension) have been reported [51]. 

Concannon JP, Edelmann A, Frich JC Jr, Kunkel G (1967) Localized radiation hepatitis as demonstrated by scintillation scanning. Radiology 89 136-139... 

Wharton JT, Delclos L, Gallager S et al (1973) Radiation hepatitis induced by abdominal irradiation with the cobalt 60 moving strip technique. Am J Roentgenol Radium Ther Nucl Med 117 73-80... 

The most common complications of radioembolization include non-target radiation (pancreatitis, GI ulcers, cholecystitis), radiation pneumonitis, radiation induced liver disease (radiation hepatitis) and biliary complications. 

Antineoplastic drug s are used cautiously in patients with renal or hepatic impairment, active infection, or other debilitating illnesses, or in those who have recently completed treatment with other antineoplastic drug > or radiation tiierapy. 

Beagle dog inhalation "CeCl, AMAD t.5-2,4 ion a, 1.6-2.1 13-16 mos 70 life span (in progress) death, bone marrow aplasia and pancytopenia, radiation pneumonitis, pulmonary fibrosis, hepatic necrosis 11/48 Yes pulmonary adenoma, bronchtogenic adenocarcinoma 3/48 Yes he man- Yes giocarcinoma osteosarcoma, 6/48 leukemia 3/34 (primary) Benjamin et al. (1972b 1976c) Merickel et al. (1978)... 

Fig. 1. Floxuridine radiosensitization—long-term freedom from liver progression for patients with nondiffuse primary hepatobiliary cancer treated with combined radiation therapy and hepatic artery infusion of floxuridine.

The pharmacologic studies indicated that intrinsic pharmacokinetics of 5-FU hinder their ability to reproduce the conditions required for radiosensitization. Indeed, the short half-life of the drug (from hepatic removal) preclude anything other than addictive effects when bolus drug is added to any variety of radiation fractionation scheme. These two sets of requirements together demonstrated that a continuous infusion (in which drug is made present for at least 24 h after each radiation fraction) would be optimal. In summary, 5-FU is a potent radiosensitizer under the following defined circumstances. 

X in renal/hepatic impair Caution [D, -] Contra IT administration Disp Caps, inj SE NA (emesis in 10-30%), X BM, alopecia, X BP w/ rapid IV, anorexia, anemia, leukopenia, T risk secondary leukemias Interactions T Bleeding W/ ASA, NSAIDs, warfarin T BM suppression W/ antineoplastics radiation T effects OF cisplatin X effects OF live vaccines EMS Pt has T risk of bleeding when combined w/ ASA, NSAIDs, anticoagulants/anti-plts OD May cause N/V symptomatic and supportive... 

WARNING Administer only under sup vision of a healthcare provider experienced in leukemia and in an institution w/ resources to maintain a pt compromised by drug tox Uses Acute leukemias CML in blast crisis, breast CA Action DNA intercalating agent i DNA topoisom ases I II Dose (Per protocol) 10-12 mg/mVd for 3-4 d 4- in renal/hepatic impairment Caution [D, -] Contra Bilirubin >5 mg/dL, PRO Disp Inj 1 mg/mL (5, 10, 20 mg vials) SE X BM, cardiotox, N/V, mucositis, alopecia, IV site Rxns, rarely -1- renal/hepatic Fxn Interactions Myelo-suppression W/ antineoplastic drugs and radiation therapy -1- effects OF live virus vaccines EMS Monitor for S/Sxs of Infxn OD May cause N/V, t Infxn risk and cardio/GI tox symptomatic and supportive... 

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