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Purpose: The liver is the largest organ in the abdomen and is often irradiated in radiotherapy for non-hepatic malignancies. As most of the studies on changes in liver volume are on hepatocellular carcinoma based on liver dysfunction, there are few studies on healthy liver. In this study, we investigated the relationship between absorbed dose and changes in liver volume after chemoradiotherapy for esophageal cancer in patients without apparent pre-treatment liver dysfunction. Materials and methods: Liver volume was compared between pre-treatment, acute (< 4 months) and late post-treatment (≥ 4 and < 13 months) phases in 12 patients using abdominal plain CT images. Volume changes were evaluated separately for the right and left lobes. We investigated the relationship between the volume change and VxGy (percentage of volume received x Gy or more dose). In addition, volume change for each absorbed dose was investigated using deformable image registration. Results: The volume of the left lobe showed a significant decrease between pre-treatment and acute post-treatment phases (p < 0.001), while the volume of right lobe and between acute and late post-treatment phase of left lobe did not. The mean value of the volume reduction rate of the left lobe was 51.1% and equivalent to the mean value of V30Gy. As a result of the volume change for each absorbed dose, the volume reduction rate increased as the absorbed dose increased, and a significant volume loss was observed at doses above 11 Gy. Conclusion: Volume of the liver significantly decreased only in the acute phase after chemoradiotherapy for esophageal cancer. The tolerable dose for a healthy liver is generally considered to be 30 Gy, but attention should be paid to lower doses to avoid radiation-induced liver injury. [ABSTRACT FROM AUTHOR]

Introduction: This is a case report of a patient of lymphoma with liver metastasis who had persistent pain and jaundice despite multiple lines of chemotherapy. She underwent palliative liver irradiation. This is an uncommon modality due to fear of radiation induced hepatitis. We reviewed literature available on the use of liver irradiation for palliation and concluded that it can be safely used with good results. A 33-year-old female with Non-Hodgkin’s Lymphoma (NHL) presented with obstructive jaundice. She underwent stenting followed by chemotherapy. She was lost to follow up to later present with a progressively increasing right hypochondrial mass, pain and icterus. Ultrasound abdomen revealed massive hepatomegaly with hypodense lesions in both liver lobes and centring the porta with dilatation of biliary radicals. Despite multiple lines of chemotherapy and use of opioids, there was no symptomatic relief in pain, size of mass or any decrease in biochemical parameters. Then she was offered palliative radiation in the form of partial liver irradiation to a dose of 21 Gy/7 fractions. She had >50% pain relief after 2 fractions and was off opioids by last fraction. Liver span reduced from 6 cm to 1 cm below costal margin in mid clavicular line. Radiologically 60% reduction in size of liver lesions was observed. Also, a decreasing trend in biochemical parameters was observed. Use of whole or partial liver irradiation is rare in clinical practice due to fear of radiation induced hepatitis by conventional techniques. Newer techniques of delivering radiation can highly improvise accuracy and permit further dose escalation.

Abstract Introduction Incidental liver irradiation during breast radiotherapy can increase the risk of second primary malignancy and induce adverse inflammatory states. This study establishes the volume of liver irradiated during free-breathing breast radiotherapy. Novel associations between liver dose-volume data and systemic interleukin-6 soluble receptor and blood counts are evaluated. Methods The volume of liver within the 10%, 50% and 90% isodose was determined for 100 women with stage 0 to II breast carcinoma undergoing 40Gy in 15 fractions over three weeks tangential irradiation. Blood counts and interleukin 6 soluble receptor concentration were recorded before, during and four weeks after radiotherapy. Dose-volume data for right-sided treatments was associated with longitudinal measures at bivariate and multivariable levels. Results A maximum of 226cm3 (19%), 92 cm3 (8%) and 62 cm3 (5%) of the liver was irradiated within the 10%, 50% and 90% isodose. Liver irradiation was almost exclusively a feature of the 52 right-sided treatments and was strongly correlated with breast volume (ρ = 0.7, p < 0.0001). Liver V10% was significantly associated with interleukin-6 soluble receptor concentration four weeks post-radiotherapy (beta = 0.38, p = 0.01) after controlling for theoretical confounding variables. Conclusion Up to 8% of the liver is irradiated within the primary beam during local right-sided breast radiotherapy. Select use of a deep inspiration breath hold technique would reduce this volume, and minimise the risk of radiation-induced malignancy and acute systemic elevation of inflammatory interleukin 6 soluble receptor. Highlights • A portion of the liver is irradiated for some patients during free breathing breast radiotherapy. • The likelihood of liver irradiation increases with breast size/volume. • Low dose to a larger volume of liver associated with a systemic inflammatory mediator. [ABSTRACT FROM AUTHOR]

Background/Aim IL-6 - IL-1- lipocalin2 (LCN2) - liver irradiation - oxidative stress - TNF-a Lipocalin2 ( LCN2) is an acute phase protein. The source of its increased serum level in oxidative stress conditions ( ROS) remains still unknown. We prospectively evaluate the serum LCN2 increase after single dose liver irradiation along with hepatic LCN2 gene and protein expression. Methods A single dose of 25 Gray was administered percutaneously to the liver of randomly paired rats after a planning CT scan. Male Wistar rats were sacrificed 1, 3, 6, 12, 24 and 48 h after irradiation along with sham-irradiated controls. ELISA, RT- PCR, Western blot and immunofluorescence staining was performed. Furthermore, hepatocytes, myofibroblasts and Kupffer cells were isolated from the liver of healthy rats and irradiated ex-vivo. Results After liver irradiation, LCN2 serum levels increased significantly up to 2.7 μg/ml within 6 h and stayed elevated over 24 h. LCN2 specific transcripts increased significantly up to 552 ± 109-fold at 24 h after liver irradiation, which was further confirmed at protein level. α2-macroglobulin and hemoxygenase-1 also showed an increase, but the magnitude was less as compared to LCN2. LCN2+ granulocytes were detected within 1 h after irradiation around central and portal fields and remained high during the course of study. Ex-vivo irradiated hepatocytes (2.4 ± 0.6-fold) showed a higher LCN2 gene expression as compared to myofibroblasts and Kupffer cells. IL-1β treatment further increased LCN2 gene expression in cultured hepatocytes. Conclusions Single dose liver irradiation induces a significant increase in LCN2 serum levels, comparable to the induction of acute phase proteins. We suggest LCN2 as marker for the early phase of radiation-induced tissue damage. [ABSTRACT FROM AUTHOR]

Purpose: The ability to predict normal tissue complication probability (NTCP) is essential for NTCP-based treatment planning. The purpose of this work is to estimate the Lyman NTCP model parameters for liver irradiation from published clinical data of different fractionation regimens. A new expression of normalized total dose (NTD) is proposed to convert NTCP data between different treatment schemes. Method and Materials: The NTCP data of radiation- induced liver disease (RILD) from external beam radiation therapy for primary liver cancer patients were selected for analysis. The data were collected from 4 institutions for tumor sizes in the range of of 8-10 cm. The dose per fraction ranged from 1.5 Gy to 6 Gy. A modified linear-quadratic model with two components corresponding to radiosensitive and radioresistant cells in the normal liver tissue was proposed to understand the new NTD formalism. Results: There are five parameters in the model: TD50, m, n, α/β and f. With two parameters n and α/β fixed to be 1.0 and 2.0 Gy, respectively, the extracted parameters from the fitting are TD50 (1) = 40.3 ± 8.4Gy, m =0.36 ± 0.09, f = 0.156 ± 0.074 Gy and TD 50 (1) = 23.9 ± 5.3Gy, m = 0.41 ± 0.15, f = 0.0 ± 0.04 Gy for patients with liver cirrhosis scores of Child-Pugh A and Child-Pugh B, respectively. The fitting results showed that the liver cirrhosis score significantly affects fractional dose dependence of NTD. Conclusion: The Lyman parameters generated presently and the new form of NTD may be used to predict NTCP for treatment planning of innovative liver irradiation with different fractionations, such as hypofractioned stereotactic body radiation therapy. [Copyright &y& Elsevier]

The selective uptake of boron by tumors compared to that by healthy tissue makes boron neutron capture therapy (BNCT) an extremely advantageous technique for the treatment of tumors that affect a whole vital organ. An example is represented by colon adenocarcinoma metastases invading the liver, often resulting in a fatal outcome, even if surgical resection of the primary tumor is successful. BNCT can be performed by irradiating the explanted organ in a suitable neutron field. In the thermal column of the Triga Mark II reactor at Pavia University, a facility was created for this purpose and used for the irradiation of explanted human livers. The neutron field distribution inside the organ was studied both experimentally and by means of the Monte Carlo N-particle transport code (MCNP). The liver was modeled as a spherical segment in MCNP and a hepatic-equivalent solution was used as an experimental phantom. In the as-built facility, the ratio between maximum and minimum flux values inside the phantom ([uppercase_phi_synonym]max/[uppercase_phi_synonym]min) was 3.8; this value can be lowered to 2.3 by rotating the liver during the irradiation. In this study, the authors proposed a new facility configuration to achieve a uniform thermal neutron flux distribution in the liver. They showed that a [uppercase_phi_synonym]max/[uppercase_phi_synonym]min ratio of 1.4 could be obtained without the need for organ rotation. Flux distributions and dose volume histograms were reported for different graphite configurations. [ABSTRACT FROM AUTHOR]

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Radiation therapy (RT) has traditionally not been widely used in the management of hepatic malignancies for fear of toxicity in the form of radiation-induced liver disease (RILD). Pre-clinical hepatic irradiation models can provide clinicians with better understanding of the radiation tolerance of the liver, which in turn may lead to the development of more effective cancer treatments. Previous models of hepatic irradiation are limited by either invasive laparotomy procedures, or the need to irradiate the whole or large parts of the liver using external skin markers. In the setting of modern-day radiation oncology, a truly translational animal model would require the ability to deliver RT to specific parts of the liver, through non-invasive image guidance methods. To this end, we developed a targeted hepatic irradiation model on the Small Animal Radiation Research Platform (SARRP) using contrast-enhanced cone-beam computed tomography image guidance. Using this model, we showed evidence of the early development of region-specific RILD through functional single photon emission computed tomography (SPECT) imaging. [ABSTRACT FROM AUTHOR]

Introduction: This is a case report of a patient of lymphoma with liver metastasis who had persistent pain and jaundice despite multiple lines of chemotherapy. She underwent palliative liver irradiation. This is an uncommon modality due to fear of radiation induced hepatitis. We reviewed literature available on the use of liver irradiation for palliation and concluded that it can be safely used with good results. A 33-year-old female with Non-Hodgkin's Lymphoma (NHL) presented with obstructive jaundice. She underwent stenting followed by chemotherapy. She was lost to follow up to later present with a progressively increasing right hypochondrial mass, pain and icterus. Ultrasound abdomen revealed massive hepatomegaly with hypodense lesions in both liver lobes and centring the porta with dilatation of biliary radicals. Despite multiple lines of chemotherapy and use of opioids, there was no symptomatic relief in pain, size of mass or any decrease in biochemical parameters. Then she was offered palliative radiation in the form of partial liver irradiation to a dose of 21Gy/7 fractions. She had >50% pain relief after 2 fractions and was off opioids by last fraction. Liver span reduced from 6cm to 1cm below costal margin in mid clavicular line. Radiologically 60% reduction in size of liver lesions was observed. Also, a decreasing trend in biochemical parameters was observed. Use of whole or partial liver irradiation is rare in clinical practice due to fear of radiation induced hepatitis by conventional techniques. Newer techniques of delivering radiation can highly improvise accuracy and permit further dose escalation., (Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)

The aim of this study is to investigate whether partial liver irradiation promotes hepatic regeneration in rat. Left-half liver of rat was irradiated to 10 Gy, and the Right-half to 0, 5, 10 and 15 Gy, respectively. Then, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) levels were evaluated on 0 day, 15-day, 30-day, 45-day and 60-day after liver irradiation. Next, the serum HGF, NF-κB and TGF-β1 levels were also analyzed on 60-day after liver irradiation. Lastly, the cyclinD1 protein expression was appraised by western blots on 60-day after liver irradiation. ALT, AST and ALP levels were reduced compared with that of controls. The serum HGF, NF-κB and TGF-β1 levels, and the cyclinD1 protein expression in liver irradiation group were increased compared with that of controls group. However, hepatic regeneration of higher dose-irradiated cirrhotic liver was triggered a more enhanced regeneration, compared with that of higher doses group. In summary, these results suggest that different doses of partial liver irradiation promotes hepatic regeneration in rat.