Long-term follow-up study of gastroduodenal lesions after radioembolization of hepatic tumors

Rodríguez‐Lago, Iago; Carretero, Cristina; Herráiz, Maite; Súbtil, José Carlos; Betés, Maite; Rodríguez‐Fraile, Macarena; Sola, Jesús Javier; Bilbao, J.I.; Muñoz-Navas, Miguel; Sangro, Bruno

doi:10.3748/wjg.v19.i19.2935

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…Several retrospective analyses of large cohorts reported a similar incidence of 1.9%‐3.2% . The natural history has been described in detail . Symptoms are usually mild to moderate and last for 4‐10 months despite treatment, but full symptomatic and endoscopic recovery normally occurs, as shown in Fig.…”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 81%

“…Radiation‐induced GI ulcerations are an uncommon complication of SIRT that presents usually 2‐6 weeks after SIRT with symptoms of acute epigastric pain, nausea, vomiting, dyspepsia, and sometimes anorexia . Ulcers are usually multiple (0.5‐2 cm in size) but can also be “diffuse” and unmeasurable and often associated with diffuse mucositis . The ulcers typically have a chronic, insidious course with symptoms persisting for weeks despite appropriate therapy.…”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

“…. Complications include pyloric stricture, hemorrhage, severe anemia with transfusion needs, bilioenteric fistula, and death …”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

“…Failure to retrospectively detect extrahepatic uptake of radioactivity in the post‐SIRT scans in these patients should not lead to delayed evaluation. The presence of multiple mucosal erosions and ulcerations or a single large ulcer, usually associated with diffuse mucositis, and the distribution of the lesions, usually involving the distal gastric body, antrum, pylorus, and the duodenal bulb, allow the presumptive diagnosis . The poor healing of the radiated site often discourages regular biopsies that will unlikely change patient management.…”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

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Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

et al. 2017

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Selective internal radiation therapy (or radioembolization) by intra-arterial injection of radioactive yttrium-90-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high-dose beta-radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off-target diversion of yttrium-90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization-induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (Hepatology 2017;66:969-982).

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Section: Gastrointestinal Ulcerationsmentioning

confidence: 81%

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

“…. Complications include pyloric stricture, hemorrhage, severe anemia with transfusion needs, bilioenteric fistula, and death …”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

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Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

et al. 2017

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“…Hence, the absence of angiographically concealed arterial shunts has to be approved prior to treatment. In particular, all patients must be subjected to shunt evaluation using technetium-99 macroagglutinated albumin (Tc-MAA), SPECT and angiographic imaging (39,43). In 1999, Canada was the first country to approve Y90-RE for palliative treatment of hepatic malignancies.…”

Section: Y90-re-backgroundmentioning

confidence: 99%

Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

Savic¹,

Chapiro²,

Geschwind³

2017

Hepatobiliary Surg. Nutr.

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Intrahepatic cholangiocarcinoma (ICC) is a rare disease and carries a poor prognosis with surgery remaining the only curative treatment option. However, due to the late presentation of symptoms and close proximity of the tumors to central hepatic structures, only about 30% of patients are classified eligible to resection. As for palliative approaches, ICC constitutes a possible indication for loco-regional therapies (LRT). As such, intra-arterial therapies (IAT) are reported to be feasible, safe and effective in inducing tumor response in unresectable ICC. The paradigm of IAT is premised on the selective delivery of embolic, chemotherapeutic agents to the tumor via its feeding arteries, thus allowing dose escalation within the carcinoma and reduction of systemic toxicity. Conventional transcatheter arterial chemoembolization (cTACE) so far remains the most commonly used IAT modality. However, drug-eluting beads (DEB)-TACE was initiated with the idea of more selective targeting of the tumor owing to the combined embolizing as well as drug-eluting properties of the microspheres used in this setting. Moreover, radioembolization is performed by intra-arterial administration of very small spheres containing β-emitting yttrium-90 (Y90-RE) to the site of the tumor. Clinical evidence exists in support of survival benefits for IAT in the palliative treatment of ICC compared to surgery and systemic chemotherapy. As for combination regimens, cTACE, DEB-TACE and Y90-RE are reported to achieve conversion of patients to surgery in a sequential treatment planning and simultaneous IAT combinations may provide a therapeutic option for treatment escalation. Regarding the current status of literature, controlled randomized prospective trials to compare different IAT techniques and combination therapies as well as treatment recommendations for different IAT modalities are needed.

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Complications of Intra-Arterial Regional Liver Therapy

Spolverato

Deipolyi

D’Angelica

2019

Cancer Regional Therapy

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Long-term follow-up study of gastroduodenal lesions after radioembolization of hepatic tumors

Abstract: All patients were free from severe symptoms at the end of follow-up. The routine use of SPECT has decreased the incidence of gastrointestinal lesions due to unintended deployment of ⁹⁰Y particles.

Cited by 21 publications

References 15 publications

Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

Complications of Intra-Arterial Regional Liver Therapy

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