Gastrointestinal Complications Associated with Hepatic Arterial Yttrium-90 Microsphere Therapy

Murthy, Ravi; Brown, Daniel B.; Salem, Riad; Meranze, Steven G.; Coldwell, Douglas M.; Krishnan, Sunil; Núñez, Rodolfo; Habbu, Amit; Liu, David; Ross, William A.; Cohen, Alan M.; Censullo, Michael L.

doi:10.1016/j.jvir.2007.02.002

Cited by 157 publications

(105 citation statements)

References 31 publications

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“…Reported side effects of Y-90 microsphere treatment are pulmonary fibrosis, gastroduodenal ulcer and radiation cholecystitis [23][24][25][26][27][28]. These adverse effects are caused by extrahepatic leakage of Y-90 microspheres.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

Kim

et al. 2010

Nucl Med Mol Imaging

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Purpose Y-90 resin microsphere radioembolization is used to treat inoperable hepatic tumors. After injection of Y-90 resin microsphere, the only method to visualize the distribution of Y-90 is the scintigraphic imaging of bremsstrahlung radiation. The purpose of this study was to evaluate the characteristics and usefulness of bremsstrahlung imaging in Y-90 resin microsphere treatment. Methods Twenty patients (22 administrations) underwent intra-arterial Y-90 resin microsphere treatment. For pretreatment planning, images of Tc-99m albumin macroaggregate (MAA) arterial injection and hepatic contrast angiography were obtained. Post-treatment bremsstrahlung images were taken and compared with pre-treatment images. The extrahepatic activity was evaluated on bremsstrahlung images. To correlate the size and vascularity of the tumors with tumor visualization on bremsstrahlung images, the individual tumors were grouped according to visualization on each image and compared with one another by size and tumor-to-normal ratio. Results All post-therapeutic bremsstrahlung images showed similar contours of the liver with pre-treatment angiography. No extrahepatic activity was seen in all cases. The visualized tumors on bremsstrahlung images were significantly larger than the non-visualized tumors. Tumor-to-normal ratios of the visualized tumors on bremsstrahlung images were significantly higher than those of the non-visualized tumors. Conclusions Bremsstrahlung images after intra-arterial Y-90 resin microsphere treatment are useful in evaluating the intrahepatic distribution of radioisotope and detecting possible extrahepatic activity.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

Kim

et al. 2010

Nucl Med Mol Imaging

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“…It occurs in less of 1 % of patients if standard dosimetry is performed [37]. Gastrointestinal ulcerations and pancreatitis occur in less than 5 % of patients after meticulous patient preparation [38]. RILD eventually occurs in up to 4 % of patients, and it is more common in patients with preexisting liver dysfunction [39].…”

Section: Toxicity and Complicationsmentioning

confidence: 99%

Standards of Practice in Transarterial Radioembolization

Mahnken

Spreafico

Maleux

et al. 2013

Cardiovasc Intervent Radiol

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“…Although potentially an effective therapy, a number of complications can occur, even in the hands of an experienced operator. Gastrointestinal side effects are common, ranging from nausea, epigastric discomfort, vomiting, and anorexia [13] to cholecystitis, hepatitis, and gastroduodenal ulceration [14 -16]. However, the majority of side effects are mild and serious complications are uncommon in appropriately selected patients, with several large series documenting the feasibility of delivering this treatment to a wide variety of patients, including a significant number of elderly patients (Ͼ65 years) and those with an ECOG performance status score Ͼ1 [4,17].…”

Section: Sir-spheres Consist Of Microspheres Containingmentioning

confidence: 99%

“…Despite a detailed pretreatment angiography, cases of duodenal ulceration from inadvertent deposition of SIRSpheres have been reported in the literature [21,22], with reported incidence rates of 0%-20% (median, 8%) [12,13,16]. The two largest series of patients with secondary liver tumors from colorectal or other malignancies reported rates of grade 3 gastrointestinal ulceration of 1%-2% [4,17].…”

Section: Sir-spheres Consist Of Microspheres Containingmentioning

confidence: 99%

“…The two largest series of patients with secondary liver tumors from colorectal or other malignancies reported rates of grade 3 gastrointestinal ulceration of 1%-2% [4,17]. Cases have been reported both with and without the use of prophylactic proton pump inhibitors, with ulcers most commonly occurring in the pylorus, antrum, or duodenum [12,13,16]. Aside from aberrant vasculature, no series have identified other risk factors for ulceration, although cases with poor outcomes have described other comorbidities complicating treatment options, as with our case.…”

Section: Sir-spheres Consist Of Microspheres Containingmentioning

confidence: 99%

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A Serious Complication of Selected Internal Radiation Therapy: Case Report and Literature Review

2010

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The use of selective internal radiation therapy (SIRT) with SIR-Spheres (Sirtex, Sydney, Australia) is increasingly recognized as a potential therapeutic modality of primary and secondary malignant liver tumors. A number of treatment-related complications have been described despite technical expertise and detailed pretreatment investigations to assess suitability. We describe a case of gastric ulceration from nontargeted deposition of SIR-spheres in the gastric mucosa with life-threatening consequences. This case highlights the need for careful screening and appropriate patient selection, and the need to recognize ulceration from SIRT as a potential complication of treatment. The characteristic endoscopic, radiologic, and histopathologic findings are illustrated and recommendations are reviewed with regard to the current literature. The Oncologist 2010;15:830 -835 CASE REPORTSelective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-emitting microspheres is increasingly recognized as an effective therapy of both primary and secondary hepatic malignancies [1][2][3][4][5]. Increasing reports have shown this to be a useful treatment for unresectable hepatic metastases from colorectal carcinoma [6], neuroendocrine tumors [7], and primary hepatocellular carcinoma [3,8,9]. A number of treatment-related complications have been described despite technical expertise and detailed pretreatment investigations to assess suitability. We describe a case of gastric ulceration from aberrant deposition of SIR-Spheres (Sirtex, Sydney, Australia) in the gastric mucosa with lifethreatening consequences.The patient, a 63-year-old male with metastatic colorectal cancer, received SIRT 17 weeks earlier at another institution for recurrent, inoperable hepatic metastatic disease. The original diagnosis of rectosigmoid adenocarinoma was made 3 years earlier following an episode of infective endocarditis with Streptococcus viridians.

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Gastrointestinal Complications Associated with Hepatic Arterial Yttrium-90 Microsphere Therapy

Cited by 157 publications

References 31 publications

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

Standards of Practice in Transarterial Radioembolization

A Serious Complication of Selected Internal Radiation Therapy: Case Report and Literature Review

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