Incidence of Radioembolization-Induced Liver Disease and Liver Toxicity Following Repeat 90Y-Radioembolization

Abstract

Purpose The complication profile following repeat 90Y-radioembolization (RE) is not well understood, and repeat RE is sometimes avoided because of concerns for RE-induced liver disease (REILD) and liver toxicity. The purpose of this study was to examine the incidence of REILD and liver toxicity following repeat 90Y-RE and to identify potential risk factors. Methods A retrospective analysis of patients undergoing repeat RE to the same hepatic lobe between 2013 and 2018 was performed. Baseline factors were evaluated as predictors of liver toxicity, mortality, and REILD, which was defined as the presence symptomatic ascites or jaundice in the absence of biliary obstruction within 8 weeks following RE. Post-RE complications were graded according to the Common Terminology Criteria for Adverse Events version 5. Results A total of 39 patients underwent repeat RE with 14 (35.9%) experiencing Common Terminology Criteria for Adverse Events toxicity of grade 2 or greater, 3 (10.3%) grade 3, and no grade 4 or greater. A Model for End Stage Liver Disease score of 8 or greater was associated with grade 2 toxicity or greater (26.7% vs 75%; P = 0.013). Only 3 patients (7.7%) experienced REILD due to symptomatic ascites without jaundice. Greater than 2 REs were associated with a greater rate of 6-month mortality (12% vs 58.3%, P = 0.003), 12-month mortality (28% vs 75%, P = 0.007), and REILD (0% vs 21.4%, P = 0.016). Age, sex, microsphere type, cirrhosis, Child-Pugh, and Eastern Cooperative Oncology Group status were not significantly associated with complications, REILD, or survival. Conclusions Repeat 90Y-RE appears to be well tolerated with a low rate of high-grade adverse events and REILD.

Yttrium-90 Radioembolization Dosimetry: What Trainees Need to Know

“…[80][81][82] Risk factors for REILD are not fully understood, but they have been postulated to be associated with prior intra-arterial treatments (especially in more than two Y90-RE therapies), neoadjuvant or adjuvant chemotherapy, baseline cirrhosis, baseline model for end-stage liver disease (MELD) score greater than 8, and an elevated total administered dose. 80,81,[83][84][85][86][87] Regarding dosimetry planning in the setting of Y90-RE retreatment, judicious attention should be given to the cumulative absorbed dose to the lungs and nontumor liver tissue. Although no specific lifetime cumulative dose limit has been established for nontumor liver tissue, 8,82 personalized dose planning is recommended to deliver the highest tolerable tumor dose while minimizing the dose to nontumoral tissue.…”

Role of Resin Microsphere Y90 Dosimetry in Predicting Objective Tumor Response, Survival and Treatment Related Toxicity in Surgically Unresectable Colorectal Liver Metastasis: A Retrospective Single Institution Study

“…Overall, 6 (13.3%) patients developed grade ≥ 3 liver toxicity post Y90, of whom 2 (4.4%) patients developed REILD, which in this study was classified as the development of ascites or jaundice in the absence of biliary obstruction within 8 weeks of Y90 RE in the absence of progression of intrahepatic tumors [ 15 ]. Of the remaining 4 patients, 3 patients had a resolution of grade ≥ 3 liver toxicity and 1 patient had stable toxicity at 1-year post Y90 radioembolization.…”

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

“…Limited data on the feasibility of retreatment with radioembolization is available [114][115][116][117]. Based on the published literature, retreatment with radioembolization is feasible, has an acceptable toxicity profile and can be considered, especially in patients who responded to the first radioembolization treatment.…”