Radiation therapy

Acute radiation-induced liver disease also causes endothelial cell injury that is characteristic of VOD/SOS.[64]

In adults, the whole liver has tolerance up to 30 Gy to 35 Gy with conventional fractionation, the prevalence of radiation-induced liver disease varies from 6% to 66% based on the volume of liver involved and on hepatic reserve.[64,65]

Radiation hepatopathy after contemporary treatment appears to be uncommon in long-term survivors without predisposing conditions, such as viral hepatitis or iron overload.[66]

The risk of injury in children increases with radiation dose, hepatic volume, younger age at treatment, previous partial hepatectomy, and concomitant use of radiomimetic chemotherapy, such as dactinomycin and doxorubicin.[67-70]

Survivors who received radiation doses of 40 Gy to at least one-third of the liver volume, doses of 30 Gy or higher to the whole abdomen, or an upper abdominal field involving the entire liver are at highest risk for hepatic dysfunction.[42]

A PENTEC comprehensive review was performed to develop models to inform dose constraints for radiation-associated hepatic toxicity.[71]

A PENTEC comprehensive review was performed to develop models to inform dose constraints for radiation-associated hepatic toxicity.[71]

In a model developed to calculate the risk of developing SOS after whole-liver radiation therapy, radiation dose and receipt of nonalkylating chemotherapy were significant. Age younger than 20 years at the time of radiation therapy was borderline significant.

A PENTEC comprehensive review was performed to develop models to inform dose constraints for radiation-associated hepatic toxicity.[71]

The predicted risk of SOS was 2% with zero radiation therapy dose, 6.1% after treatment with 10 Gy, and 14.5% after treatment with 20 Gy to the whole liver.

A PENTEC comprehensive review was performed to develop models to inform dose constraints for radiation-associated hepatic toxicity.[71]

Patients with Wilms tumor treated with right flank radiation therapy (estimated dose, 6.54 ± 2.50 Gy) had a higher observed rate of SOS than patients who received left flank radiation therapy (estimated dose, 2.16 ± 1.15 Gy).

A PENTEC comprehensive review was performed to develop models to inform dose constraints for radiation-associated hepatic toxicity.[71]

Data were sparse regarding rates of late liver injury after radiation therapy, which suggests low rates of severe toxicity after treatment for common pediatric malignancies.