%0 Journal Article
%T Liver Injury Induced by Anticancer Chemotherapy and Radiation Therapy
%A Y. Maor
%A S. Malnick
%J International Journal of Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/815105
%X Cytotoxic chemotherapy prolongs survival of patients with advanced and metastatic tumors. This is, however, a double-edged sword with many adverse effects. Since the liver has a rich blood supply and plays an active role in the metabolism of medications, it is not surprising that there can be hepatic injury related to chemotherapy. In addition, radioembolization may affect the parenchyma of normal and cirrhotic livers. We review chemotherapy-associated liver injury in patients with colorectal liver metastases, including downsizing chemotherapy and neoadjuvant chemotherapy. We discuss the mechanism of the hepatic injury, secondary to reactive oxygen species, and the spectrum of hepatic injury including, steatosis, steatohepatitis, hepatic sinusoidal injury and highlight the pharmacogenomics of such liver insults. Methods for reducing and treating the hepatotoxicity are discussed for specific agents including tamxifen and the newly introduced targeted antibodies. 1. Introduction Over the last few decades many novel cytotoxic chemotherapeutic agents have been developed which prolong survival of patients with advanced and metastatic tumors., More recently, specifically targeted antibodies and other biological agents have been introduced in various combinations with chemotherapy to further increase life expectancy. For some tumors, for example, colorectal cancer (CRC), preoperative treatment may ˇ°downsizeˇ± liver metastases to make them compatible with complete resection with a curative intent. External radiation therapy has been an integral part of the armamentarium against primary or metastatic liver tumors. Currently, radiation may be directly targeted at liver tumors with the radioembolization technique. This increased availability of beneficial treatment modalities does not come without a price. Administration of chemotherapy has always been complicated with many adverse effects. In this review we will focus on the effects of chemotherapy and radiotherapy on the liver. The liver may be affected by various pathological manifestations, some culminating in severe liver injury and even liver failure. Chemotherapy-induced liver injury may also bear on the morbidity and mortality after hepatic resection. Radioembolization, although relatively safe, may affect the parenchyma of normal and cirrhotic livers. 2. Chemotherapy-Associated Liver Injury in Patients with Colorectal Liver Metastases In the absence of any treatment, the prognosis of patients with liver metastases from CRC is dismal [1]. In those patients with resectable disease, liver surgery with
%U http://www.hindawi.com/journals/ijh/2013/815105/