Prognostic factors and prevention of radioembolization-induced liver disease

Abstract

Radioembolization (RE)‐induced liver disease (REILD) has been defined as jaundice and ascites appearing 1 to 2 months after RE in the absence of tumor progression or bile duct occlusion. Our aims were to study the incidence of REILD in a large cohort of patients and the impact of a series of changes introduced in the processes of treatment design, activity calculation, and the routine use of ursodeoxycholic acid and low‐dose steroids (modified protocol). Between 2003 and 2011, 260 patients with liver tumors treated by RE were studied (standard protocol: 75, modified protocol: 185). REILD appeared only in patients with cirrhosis or in noncirrhosis patients exposed to systemic chemotherapy prior to RE. Globally, the incidence of REILD was reduced in the modified protocol group from 22.7% to 5.4% and the incidence of severe REILD from 13.3% to 2.2% (P < 0.0001). Treatment efficacy was not jeopardized since 3‐month disease control rates were virtually identical in both groups (66.7% and 67.2%, P = 0.93). Exposure to chemotherapy in the 2‐month period following RE and being treated by the standard protocol were independent predictors of REILD among noncirrhosis patients. In cirrhosis, the presence of a small liver (total volume <1.5 L), an abnormal bilirubin (>1.2 mg/dL), and treatment in a selective fashion were independently associated with REILD. Conclusion: REILD is an uncommon but relevant complication that appears when liver tissue primed by cirrhosis or prior and subsequent chemotherapy is exposed to the radiation delivered by radioactive microspheres. We designed a comprehensive treatment protocol that reduces the frequency and the severity of REILD. (HEPATOLOGY 2013)

Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

“…In accordance to our results, Gil-Alzugaray [5] reported no relevant RILD in the treated patients with normal liver parenchyma, but in patients with cirrhosis or prior and subsequent chemotherapy.…”

“…These can be on the one hand complications b Fig. 2 due to the RE treatment [5,15,24,29,30] and on the other hand complications due to coil embolization associated with the therapy [1,19,25,28]. Peterson et al [24] performed a study in order to estimate the incidence of complications after 90 Y microsphere RE for unresectable hepatic tumors.…”

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

“…Simultaneously, proinflammatory pathways are activated, resulting in endothelial injury with the activation of the coagulation cascade (57). Jaundice and ascites, in the absence of tumor progression or bile duct dilatation, are the main symptoms of radioembolization-induced liver disease (56,58). General risk factors for developing radioembolization-induced liver disease include prior chemotherapy, low tumor burden, high baseline bilirubin values, and cirrhotic liver disease (56,58).…”

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

“…The use of SIRT is less likely in the situation of non-liver-dominant disease. In a cohort study of 260 patients, it was found that REILD only occurred in patients who had cirrhosis or who had been exposed to prolonged chemotherapy (50). The type of chemotherapeutic agent did not impact on the incidence of REILD.…”