Gastroduodenal Ulcerations As a Delayed Complication of Hepatic Metastasis Radioembolization

Nair, Jayan; Liu, Chen; Caridi, James G.; Zlotecki, Robert A.; George, Thomas J.

doi:10.1200/jco.2010.29.5782

Cited by 9 publications

(11 citation statements)

References 13 publications

(9 reference statements)

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“…Histopathological examination revealed resin microspheres in the gastric wall (fig. 2) and thus suggested radiation-induced gastric ulceration, a known serious complication of 90 Y radioembolization [23,24]. Another 2 patients developed liver abscesses.…”

Section: Resultsmentioning

confidence: 99%

“…Delayed toxicities are considerable radiation-induced complications occurring weeks or months after radioembolization and are frequently caused by unintended deposition of 90 Y microspheres into organs other than the liver. Accordingly, radiation damage results in gastric ulceration [23,24], pneumonitis [32], cholecystitis [33] or pancreatitis. The occurrence of liver abscesses [34] or cholangitis due to bile duct stenosis [35] has been described as a possible complication of 90 Y radioembolization.…”

Section: Discussionmentioning

confidence: 99%

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Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic Factors

Michl¹,

Haug²,

Jakobs

et al. 2013

Oncology

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Objective: To analyze the clinical efficacy of ⁹⁰Y radioembolization in liver metastases from pancreatic cancer, to describe treatment toxicities and to identify biomarkers as predictors of outcome. Methods: Data from 19 pancreatic cancer patients (9 females/10 males) who had received ⁹⁰Y radioembolization for metastatic liver disease between 06/2004 and 01/2011 were analyzed retrospectively. Results: The median age at ⁹⁰Y radioembolization was 63 years (range 43-77). In 16 patients, previous palliative gemcitabine-based chemotherapy was given for metastatic disease. Objective response in the liver after ⁹⁰Y radioembolization was 47%. Median local progression-free survival in the liver was 3.4 months (range 0.9-45.0). Median overall survival (OS) was 9.0 months (range 0.9-53.0) and 1-year survival was 24%. Cox regression models for baseline biomarkers at ⁹⁰Y radioembolization revealed correlations of increased carbohydrate antigen 19-9 (p = 0.02) and C-reactive protein (p = 0.03) with shorter OS. Short-term adverse events (nausea, vomiting, fatigue, fever and abdominal pain) did not exceed grade 3. As long-term adverse events, liver abscesses, gastroduodenal ulceration, cholestasis and cholangitis, ascites and spleen infarction were observed. Conclusion:⁹⁰Y radioembolization is able to induce an encouraging local response rate of liver metastases of pancreatic cancer patients. Most short-term toxicities are manageable; however, patients should be followed up carefully for severe long-term toxicities.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic Factors

Michl¹,

Haug²,

Jakobs

et al. 2013

Oncology

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“…Optimal vascular flow and oxygenation are important in achieving the desired brachytherapy effects and avoiding complications. The average penetration of beta-radiation is 2.5 mm and a maximum of 11 mm of surrounding hepatic parenchyma when used to treat hepatic metastases [ 4 ]. The half-life of 90 Y is 64 hours, with 95% of the dose delivered by day 11 [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The average penetration of beta-radiation is 2.5 mm and a maximum of 11 mm of surrounding hepatic parenchyma when used to treat hepatic metastases [ 4 ]. The half-life of 90 Y is 64 hours, with 95% of the dose delivered by day 11 [ 4 ]. The tumoricidal effect of radioembolization is predominantly due to radioactivity rather than an ischemia-induced effect [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, complications can occur, predominantly due to aberrant deposition or migration of radiation microspheres into unintended nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI) tract [ 4 ]. We report a case of diffuse gastric ulceration due to radioactive yttrium seed migration to the stomach to alert clinicians to this exceptional cause of gastric injury and to the diagnostic difficulties of this underappreciated and potentially catastrophic complication of hepatic SIRT.…”

Section: Introductionmentioning

confidence: 99%

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A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization

Voruganti

Godwin

Adrain

et al. 2018

Case Reports in Medicine

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Radioembolization (RE) is a selective internal radiation therapy (SIRT) delivering targeted, high-dose, intra-arterial radiation directly to the vascular supply of liver tumors. Complications can occur due to aberrant deposition or migration of radiation microspheres into nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI) tract. We report a case of gastric ulcers due to yttrium-90 (90Y) seed migration to the stomach to alert clinicians to this rare cause of gastric injury. A 57-year-old woman with stage IV breast cancer with liver and lung metastases presented to the hospital with 2 months of worsening nausea and vomiting. Two months prior, she had received SIRT with 90Y microspheres without complications. Upper GI endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies revealed black, spherical foreign bodies, consistent with 90Y microspheres, documenting radiation injury. Radiation-induced UGI ulceration is caused by direct radiation injury from beta-radiation. Delay in diagnosis may be due to the nonspecificity of symptoms and temporal delay of symptom onset from SIRT, which was 2 months in our patient. Also, complaints may be attributed erroneously to adjuvant chemotherapy or widespread metastatic disease. Clinicians must consider radiation-associated toxicity in any SIRT-treated patient developing abdominal symptoms.

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N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

Samuelson

Louie

Sze

2012

Cardiovasc Intervent Radiol

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Gastroduodenal Ulcerations As a Delayed Complication of Hepatic Metastasis Radioembolization

Cited by 9 publications

References 13 publications

Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic Factors

Radioembolization with Yttrium-90 Microspheres (SIRT) in Pancreatic Cancer Patients with Liver Metastases: Efficacy, Safety and Prognostic Factors

A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization

N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

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