Radiation microsphere–induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity
- 30 September 2009
- journal article
- Published by Elsevier BV in Gastrointestinal Endoscopy
- Vol. 70 (3), 561-567
- https://doi.org/10.1016/j.gie.2009.03.015
Abstract
Intra-arterial infusion of yttrium-90 (Y-90) microspheres is locoregional radiation therapy for unresectable hepatic neoplasms. Literature on GI complications of this novel therapy is sparse. Clinically and pictorially characterize selective internal radiation therapy (SIRT)-induced GI injury and review the published literature. Retrospective chart analysis. Single-center tertiary referral community hospital. One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008. SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients. GI ulcers after SIRT. Five patients with suspected GI injury after SIRT were identified. Significant postprocedural symptoms included nausea/vomiting, odynophagia, hematemesis, and melena. Radiation ulcers occurred mostly in the gastric antrum, pylorus, and duodenum. Biopsy specimens of ulcer margins in 4 patients showed pathognomonic radiation microspheres. Angiographic review of the fifth patient revealed a previously unrecognized arterial branch supplying the corresponding region of GI ulceration noted on endoscopy. Small retrospective study and follow-up limited by terminal disease states in most patients. The reported incidence of GI complications after SIRT for hepatic neoplasia varies from 3% to 24% of patients. Incidence can be minimized by strict adherence to published SIRT protocols. Diagnosis requires a high degree of clinical suspicion along with endoscopy and biopsy of ulcer margins. Characteristic radiation microspheres in biopsy specimens are pathognomonic. Gastroenterologists and pathologists must be cognizant of this complication.Keywords
This publication has 22 references indexed in Scilit:
- Another Case of Severe, Chronically Symptomatic, Nonhealing Gastroduodenal Injury After Radioembolization of Hepatic TumorThe American Journal of Gastroenterology, 2007
- Gastroduodenal Injury After Radioembolization of Hepatic TumorsThe American Journal of Gastroenterology, 2007
- Gastrointestinal Complications Associated with Hepatic Arterial Yttrium-90 Microsphere TherapyJournal of Vascular and Interventional Radiology, 2007
- Yttrium-90 microspheres (TheraSphere®) treatment of unresectable hepatocellular carcinoma: Downstaging to resection, RFA and bridge to transplantationJournal of Surgical Oncology, 2006
- SELECTIVE INTERNAL RADIATION THERAPY WITH 90Y MICROSPHERES FOR COLORECTAL LIVER METASTASES: SINGLE-CENTRE EXPERIENCE WITH 100 PATIENTSAnz Journal of Surgery, 2006
- Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: Modern USA experienceInternational Journal of Radiation Oncology*Biology*Physics, 2006
- Yttrium-90 microspheres for the treatment of hepatocellular carcinomaGastroenterology, 2004
- RADIATION‐INDUCED ULCERATION OF THE STOMACH SECONDARY TO HEPATIC EMBOLIZATION WITH RADIOACTIVE YTTRIUM MICROSPHERES IN THE TREATMENT OF METASTATIC COLON CANCERJournal of Gastroenterology and Hepatology, 2004
- Randomised trial of SIR-Spheres® plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancerAnnals of Oncology, 2001
- Gastrointestinal bleeding after hepatic transcatheter arterial embolization in patients with hepatocellular carcinomaGastrointestinal Endoscopy, 1996