Biliary Complications Associated with Selective Internal Radiation (SIR) Therapy for Unresectable Liver Malignancies

Ng, Simon Siu Man; Yu, Simon C.H.; Lai, Paul B.S.; Lau, Wan Yee

doi:10.1007/s10620-008-0222-1

Cited by 15 publications

(7 citation statements)

References 21 publications

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“…This is partially supported by recent evidence of minimal or no significant biliary complications with stereotactic body radiation therapy or high‐dose hypofractionated radiation therapy for tumors located within the perihilar region . Ischemic cholangitis leading to diffuse biliary strictures has only once been reported after SIRT …”

Section: Liver Complicationsmentioning

confidence: 75%

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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: Liver Complicationsmentioning

confidence: 75%

“…(42)(43)(44) Ischemic cholangitis leading to diffuse biliary strictures has only once been reported after SIRT. (45)…”

Section: Biliary Tree Damagementioning

confidence: 99%

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

et al. 2017

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“…The varying degrees of splenomegaly that have been observed after SIRT might suggest subclinical or low-grade portal hypertension (3,22). A predominance of biliary toxicity in RMILD has been emphasized in more recent publications (23,24). A clear definition of RMILD will require well-designed studies investigating the liver dose-toxicity relationship in a systematic manner.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Güleç¹,

Sztejnberg²,

Siegel³

et al. 2010

J Nucl Med

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Selective internal radiation treatment (SIRT) via intrahepatic arterial administration of 90 Y microspheres is an effective therapeutic modality. The conventional and generally applied MIRD schema is based on the premise that the distribution of microspheres in the liver parenchyma is uniform. In reality, however, the distribution of the microspheres follows a distinct pattern, requiring that a model be developed to more appropriately estimate radiation absorbed doses to the different structural/functional elements of the hepatic microanatomy. Methods: A systematic investigation was performed encompassing a conventional average absorbed dose assessment, a compartmental macrodosimetric approach that accounts for the anticipated higher tumor-to-normal liver activity concentration ratio, dose point-kernel convolution-derived estimates, and Monte Carlo dose estimates employing a spherical and 3-dimensional hexagonal liver model, including various subunits of the hepatic anatomy, down to the micrometer level. Results: Detailed specifics of the radiation dose deposition of 90 Y microspheres demonstrated a rapid decrease in absorbed dose in and around the portal tracts where the microspheres are deposited. The model also demonstrated that the hepatocellular parenchymal and central vein doses could be at significant levels because of a cross-fire effect. Conclusion: The reported microstructural dosimetry models can help in the detailed assessment of the dose distributions in the hepatic functional subunits and in relating these doses to their effects. These models have also revealed that the there is a consistent relationship between the average liver dose as calculated by MIRD macrodosimetry and the structural dosimetry estimates in support of the clinical utility of the MIRD methodology. This relationship could be used to more realistically assess patterns of hepatic toxicity associated with the 90 Y SIRT treatment.

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“…Hence, clinical correlation with the imaging findings is necessary (56, 57). Biopsy may be needed in rare cases (34). Following are some biliary complications that have been observed after radioembolization:…”

Section: Complications Due To Aberrant Microsphere Deposition or Radimentioning

confidence: 99%

Side Effects of Yttrium-90 Radioembolization

2014

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Limited therapeutic options are available for hepatic malignancies. Image guided targeted therapies have established their role in management of primary and secondary hepatic malignancies. Radioembolization with yttrium-90 (90Y) microspheres is safe and efficacious for treatment of hepatic malignancies. The tumoricidal effect of radioembolization is predominantly due to radioactivity and not ischemia. This article will present a comprehensive review of the side effects that have been associated with radioembolization using 90Y microspheres. Some of the described side effects are associated with all transarterial procedures. Side effects specific to radioembolization will also be discussed in detail. Methods to decrease the incidence of these potential side effects will also be discussed.

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Biliary Complications Associated with Selective Internal Radiation (SIR) Therapy for Unresectable Liver Malignancies

Cited by 15 publications

References 21 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

Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Side Effects of Yttrium-90 Radioembolization

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Biliary Complications Associated with Selective Internal Radiation (SIR) Therapy for Unresectable Liver Malignancies

Cited by 15 publications

References 21 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

Hepatic Structural Dosimetry in 90Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy

Side Effects of Yttrium-90 Radioembolization

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Hepatic Structural Dosimetry in ⁹⁰Y Microsphere Treatment: A Monte Carlo Modeling Approach Based on Lobular Microanatomy