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Hepatic Dysfunction Following Radiotherapy and Management

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Radiotherapy of Liver Cancer

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Abstract

Although proper selection of patients with liver cancer minimizes the probability of occurrence of hepatic dysfunction, radiotherapy for patients with underlying liver diseases such as cirrhosis or chronic hepatitis B might lead to classic or non-classic radiation-induced liver disease. Clinically, hepatic dysfunction includes ascites, jaundice, variceal hemorrhage, hepatorenal syndrome and hepatic encephalopathy. Several factors such radiation dose, residual liver function, and treatment other than radiotherapy are involved in the development of hepatic dysfunction. Ascites is the most common manifestation of hepatic dysfunction after radiotherapy in patients with liver cancer. A strict adherence to a low-salt diet and medical therapies including diuretics and therapeutic paracentesis can control ascites. In patients with refractory ascites, liver transplantation should be considered if tumor extent after radiotherapy is decreased within usual criteria for transplantation. When patients develop jaundice during or after radiotherapy, radiation oncologists or hepatologists differentiate between obstructive jaundice and hepatocelluar jaundice, which often implies poor prognosis. Esophageal or gastric variceal bleeding is a medical emergency requiring intensive fluid resuscitation and endoscopic or interventional treatment. To prevent rebleeding from esophageal varices, endoscopic variceal ligation combined with pharmacologic therapy is necessary. Hepatic encephalopathy is a neurological or psychiatric manifestation of hepatic dysfunction resulting from inability to detoxify endogenous or exogenous compounds. Hepatic encephalopathy usually occurs late during hepatic dysfunction, requiring liver transplantation when tumor control is enough. It is essential for radiation oncologists and hepatologists to cooperate to properly manage liver cancer patients with radiation therapy.

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  1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Do Young Kim

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  1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Jinsil Seong

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Kim, D.Y. (2021). Hepatic Dysfunction Following Radiotherapy and Management. In: Seong, J. (eds) Radiotherapy of Liver Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-16-1815-4_21

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  • DOI: https://doi.org/10.1007/978-981-16-1815-4_21

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