title: Radiation-induced hepatic toxicity after radiotherapy combined with chemotherapy for hepatocellular carcinoma.
abstract: OBJECTIVE
  The purpose of the present study was to analyze hepatic toxicity following radiotherapy combined with regional chemotherapy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  From 2001 to 2003, a total of 132 patients with HCC received 3-D conformal radiation therapy (3D-CRT) combined with chemotherapy. Patients were divided into two groups based on drug localization: the transcatheter arterial chemoembolization (TACE) group, where the chemotherapeutic drug (adriamycin) was localized within the tumor, and the non-TACE group, where the drugs (adriamycin, cisplatin, 5-fluorouracil) were diffusely spread over the entire liver.
  
  
  RESULTS
  Patients were evaluated by biochemical parameters for any hepatic toxicity prior to, during, and until 12 months after 3D-CRT. Hepatic toxicity was defined as radiation-induced liver disease (RILD) or combined modality-induced liver disease (CMILD), which is defined as RILD with abnormal elevation of total bilirubin levels. In the TACE group, three patients developed RILD (5.6%) and none developed CMILD. In the non-TACE group, three patients (3.7%) and seven patients (8.8%) developed RILD and CMILD, respectively.
  
  
  CONCLUSIONS
  Hepatic toxicity following radiotherapy combined with regional chemotherapy for HCC might be influenced by the distribution of the chemotherapeutic drugs. A more precise understanding of hepatic toxicity from chemoradiotherapy will help design optimal treatments for HCC.
authors.affiliation: Departments of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Su J
authors.initials: SJ
authors.lastname: Shim
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
authors.forename: Ik J
authors.initials: IJ
authors.lastname: Lee
authors.forename: Kwang H
authors.initials: KH
authors.lastname: Han
authors.forename: Chae Y
authors.initials: CY
authors.lastname: Chon
authors.forename: Sang H
authors.initials: SH
authors.lastname: Ahn