Hepatic radiation toxicity: avoidance and amelioration.
Hepatic radiation toxicity: avoidance and amelioration.
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DOI：
10.1016/j.semradonc.2011.05.003
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发表时间：
2011-10
影响因子：
3.5
通讯作者：
Kavanagh, Brian D.
中科院分区：
文献类型：
--
作者：
Guha, Chandan;Kavanagh, Brian D.
放射治疗和放射性栓塞技术的改进使人们对放射性肝病（RILD）重新产生了兴趣。了解影响RILD机会的技术和临床参数对于指导患者选择和毒性最小化策略非常重要。“经典”RILD的特征是无黄疸性腹水和肝肿大，并且在常规分割中平均肝脏剂量约为30戈伊后不太可能发生。通过维持较低的平均肝脏剂量并使“临界体积”的肝脏免受辐射，立体定向递送技术允许安全施用较高的肿瘤剂量。对于肝细胞癌或既存肝病患者（例如，Child-Pugh评分为B或C），因为他们更容易发生以非经典模式表现的RILD。尽管尚未证实任何药物干预措施可缓解RILD，但临床前研究表明，靶向TGF-β的治疗以及干细胞、肝细胞和肝祖细胞移植作为可能恢复肝功能的策略具有潜力。此外，在大剂量化疗后静脉闭塞性肝病的临床背景下，具有纤溶和抗血栓性质的药物可以逆转肝衰竭，这表明在RILD背景下可能发挥作用。
The refinement of radiation therapy and radioembolization techniques has led to a resurgent interest in radiation-induced liver disease (RILD). Awareness of technical and clinical parameters that influence the chance of RILD is important to guide patient selection and toxicity minimization strategies. “Classic” RILD is characterized by anicteric ascites and hepatomegaly, and is unlikely to occur after a mean liver dose of approximately 30 Gy in conventional fractionation. By maintaining a low mean liver dose and sparing a “critical volume” of liver from radiation, stereotactic delivery techniques allow for the safe administration of higher tumor doses. Caution must be exercised for patients with hepatocellular carcinoma or pre-existing liver disease (e.g., Child-Pugh score of B or C), since they are more susceptible to RILD that can manifest in a non-classic pattern. Although no pharmacologic interventions have yet been proven to mitigate RILD, preclinical research demonstrates the potential for therapies targeting TGF-β and for transplantation of stem cells, hepatocytes, and liver progenitor cells as strategies that may restore liver function. Also, in the clinical setting of veno-occlusive liver disease following high-dose chemotherapy, agents with fibrinolytic and antithrombotic properties can reverse liver failure, suggesting a possible role in the setting of RILD.
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影响因子：
158.5
作者：
ANSCHER, MS;PETERS, WP;JIRTLE, RL
通讯作者：
JIRTLE, RL
影响因子：
3.4
作者：
ANSCHER, MS;CROCKER, IR;JIRTLE, RL
通讯作者：
JIRTLE, RL
影响因子：
4.8
作者：
Duncan, MR;Frazier, KS;Grotendorst, GR
通讯作者：
Grotendorst, GR
DOI：
10.1016/j.ijrobp.2009.07.1725
发表时间：
2010-09-01
影响因子：
7
作者：
Chi, Kwan-Hwa;Liao, Chao-Sheng;Mehta, Minesh P.
通讯作者：
Mehta, Minesh P.
DOI：
10.1016/j.ijrobp.2007.05.078
发表时间：
2008-01-01
影响因子：
7
作者：
Cao, Yue;Pan, Charlie;Lawrence, Theodore S.
通讯作者：
Lawrence, Theodore S.