Follow-up/Toxicity

Question 1

What are the components of the clinical syndrome of classic radiation-induced liver disease (RILD)?

Answer 1

Signs and Sx of RILD include fatigue, RUQ pain, ascites, anicteric hepatomegaly, and elevated liver enzymes (especially alk phos which occurs 2 wks–3 mos following RT).

Question 2

What is the histologic hallmark of RILD?

Answer 2

The pathologic hallmark of RILD is veno-occlusive Dz with venous congestion of the central portion of the liver lobule. Hepatocyte atrophy and fibrosis eventually develop.

Question 3

What parameters are predictive of liver function decline following 6 fx SBRT in Child–Pugh A pts?

Answer 3

Elevated baseline Child–Pugh score, low Plt, elevated mean liver dose and liver D800cc. (Velec et al., IJROBP 2017)