Yttrium-90 microsphere induced gastrointestinal tract ulceration

Abstract

Background: Radiomicrosphere therapy (RT) utilizing yttrium-90 ( 90 Y) microspheres has been shown to be an effective regional treatment for primary and secondary hepatic malignancies. We sought to determine a large academic institution's experience regarding the extent and frequency of gastrointestinal complications.

Gastroduodenal Ulceration Associated with Radioembolization for the Treatment of Hepatic Tumors: An Institutional Experience and Review of the Literature

“…In our experience, the time from radioembolization to ulcer diagnosis varied widely ranging from under 1 month to over 9 months (mean of 4 months). Other authors reported similar findings with diagnoses between 3 weeks and 7 months post 90 Y treatment [7,26,39,[41][42][43][44][45][46][47][48]. Taking into account our experience and the 21 cases from our literature review, the mean time to diagnosis is *3.2 months.…”

“…Of these, 16 presented with abdominal pain and 12 with nausea/vomiting as part of their chief complaint. While gastrointestinal bleeding did not occur in our experience, 6 of the 21 cases in the literature review presented with severe bleeding (3 melena, 2 hematemesis, 1 both) requiring transfusion, endoscopic therapy, or embolization [39,43,44]. In our experience, the time from radioembolization to ulcer diagnosis varied widely ranging from under 1 month to over 9 months (mean of 4 months).…”

“…Several patients experienced weight loss, dehydration, and malnutrition necessitating parenteral supplementation. Our literature review identified 11 publications providing detailed accounts of a total of 21 cases of radioembolizationinduced ulcers [7,26,39,[41][42][43][44][45][46][47][48]. Of these, 16 presented with abdominal pain and 12 with nausea/vomiting as part of their chief complaint.…”

“…Lesions in the pylorus and body were also commonly seen. Associated findings included gastritis, duodenitis, friability, granularity, and bleeding [7,26,39,[41][42][43][44][45][46][47][48].…”

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

“…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].…”