Learning objectives
To review the most widely used chemotherapeutic agents, as well as their mechanism of action and pattern of toxicity, focusing on radiological findings of chemo-induced hepatotoxicity.
Background
Nowadays cancer treatment is based on a multidisciplinary approach, being chemotherapy of upmost importance. Due to the availability of multiple therapeutic options, the overall survival of oncologic patients has improved. Nevertheless, these advances are not exempt from side effects since the combination of multiple drugs, the longer duration of treatments and the appearance of new agents have contributed to a higher incidence of chemo-induced hepatotoxicity.
Although these side-effects are diverse and affect nearly every organ system, this review focuses on the radiologic manifestations of chemotherapy...
Findings and procedure details
Cancer therapy has evolved to include classic cytotoxic agents in addition to newer options such as molecularly targeted agents. Their different mechanisms of action may result in a broad spectrum of clinical (ranging from asymptomatic patients to fulminant liver failure), pathological and radiological hepatic injuries, including diffuse hepatopathy (i.e. hepatitis, steatosis, fibrosis, pseudocirrhosis, or sinusoidal obstruction) or focal hepatopathy. Fig. 3 Fig. 4
FATTY LIVER DISEASE
Chemotherapy-associated steatosis and steatohepatitis (CASH) are observed in up to 47% and 28% of patients, respectively. Fatty infiltration of...
Conclusion
Knowledge of the spectrum of chemo-induced hepatotoxicity, including its radiological findings, is essential for proper management of oncologic patients.
References
Vernuccio F, Dioguardi Burgio M, Barbiera F, Cusmà S, Badalamenti G, Midiri M, et al. CT an MR imaging of chemotherapy-induced hepatopathy. Abdominal Radiology 2019; 44:3312-3324.
Ngo D, Jia JB, Green CS, Gulati AT, Lall C. Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective. Insights Imaging 2015; 6:665-677.
Robinson PJA. The effects of cancer chemotherapy on liver imaging. Eur Radiol 2009; 19:1752-1762.
Alessandrino F, Tirumani SH, Krajewski KM, Shinagare AB, Jagannathan JP, Ramaiya NH, et al. Imaging of hepatic...