Serum Alanine Aminotransferase Elevations in Survivors of Childhood Cancer

Abstract

Grade 3 or 4 hepatic injury is infrequent in CCS. Mild hepatic injury in this group may be amenable to lifestyle modifications. This article is protected by copyright. All rights reserved.

Review – Late toxicity of abdominal and pelvic radiotherapy for childhood cancer

“…The association of even low radiotherapy doses to the spleen with late infection-related mortality, [51] in contrast to ≥40 Gy as reported earlier, [50] suggests adjustment to follow-up of CCS and to dose constraints for RT planning should be made according to the more recent SIOP -Europe Radiation Oncology Working Group recommendation. [98] Dose-effect relations have also been described for elevated ALT after liver irradiation, [28] renal failure after kidney irradiation, [43,46,47] as well as anorectal disease and intestinal obstruction after abdominopelvic irradiation. [53,54] The clinical relevance in these cases is less clear, since the clinical consequences of an asymptomatic elevated ALT are unclear, [28] and the majority of late toxicity were only significantly elevated after high radiation doses (>15 -25 Gy renal dose or ≥20-30 Gy prescribed (abdomino-) pelvic dose).…”

“…[98] Dose-effect relations have also been described for elevated ALT after liver irradiation, [28] renal failure after kidney irradiation, [43,46,47] as well as anorectal disease and intestinal obstruction after abdominopelvic irradiation. [53,54] The clinical relevance in these cases is less clear, since the clinical consequences of an asymptomatic elevated ALT are unclear, [28] and the majority of late toxicity were only significantly elevated after high radiation doses (>15 -25 Gy renal dose or ≥20-30 Gy prescribed (abdomino-) pelvic dose). [43,46,47,53,54] In general, international paediatric treatment protocols give recommendations on tolerance doses to organs at risk.…”

“…[24] QUANTEC advises mean liver doses of <13-20 Gy, depending on the primary cancer and fractionation, or ≤15 Gy to ≥700 mL of normal liver. [25] A Cochrane review (updated 2019) [26] found that, based on current evidence, radiotherapy involving the liver is suggested to be a risk factor for cellular liver injury (i.e., elevated alanine aminotransferase (ALT)) [27,28] and biliary tract injury (category C). [27] Furthermore, the percentage of the liver volume irradiated (i.e., the V10, V15 and V20) was suggested to be related to the risk of cellular liver injury (category B, see Table 1), independently of the effects of busulfan and thioguanine use on this outcome.…”

“…The effect of age at diagnosis on this outcome was not reported. [28] The clinical relevance of these laboratory abnormalities remains uncertain. [26] One IGHG guideline on the topic has been published, [29] referencing the same study.…”

“…[26] One IGHG guideline on the topic has been published, [29] referencing the same study. [28] A MEDLINE search for articles published after the scope of the Cochrane review (January 2018) did not yield additional relevant articles.…”