Gastric Injury from (90)Y to Left Hepatic Lobe Tumors Adjacent to the Stomach: Fact or Fiction?

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2015 Jul 22

PMID 26194715

Citations 8

Authors

Vanessa L Gates

Ryan Hickey

Karen Marshall

Melissa Williams

Krystina Salzig

Robert J Lewandowski

Riad Salem

Affiliations

Soon will be listed here.

Abstract

Purpose: Radioembolization with (90)Y microspheres is a locoregional radiation therapy for unresectable hepatic neoplasm. Non-target delivery of (90)Y microspheres resulting in gastrointestinal (GI) symptoms is a recognized complication; there is minimal knowledge regarding the radiation effect to the gastric wall from left hepatic lobe (90)Y treatments. Our aim was to study the incidence of GI complications when the target tissue (hepatic parenchyma ± tumor) is in close proximity to the gastric wall. We hypothesized that liver (tumor) to stomach proximity does not correlate with increased toxicity.

Methods: Between November 2011 and September 2013, we studied all patients who underwent left lobe radioembolization with (90)Y glass microspheres. With Institutional Review Board (IRB) approval, we retrospectively reviewed MRI/CT images of these patients, identifying a subset of patients with the left hepatic lobe <1 cm from the gastric wall. Patients were seen in clinic 1 month posttreatment and subsequently at 3-month intervals. Short- and long-term gastric adverse events were tabulated.

Results: Ninety-seven patients successfully underwent left hepatic lobe (90)Y microsphere radioembolization in which the average distance from the liver to the stomach wall was 1.0 ± 2.8 mm. The average dose for patients who received radioembolization to the left hepatic lobe was 109 ± 57 Gy. Fifty patients had tumor within 1 cm of the gastric wall. The average dose for patients who received radioembolization to the left hepatic lobe with tumor within 1 cm of the gastric wall was 121 ± 41 Gy. There were no reportable or recordable medical events. Of the patients, 34% reported abdominal pain that was grade 1-2; 65% of the patients reported no abdominal pain. None of the 97 patients developed a clinically evident GI ulcer.

Conclusion: Patients with left lobe tumors adjacent to or abutting the stomach do not exhibit acute or chronic radiation effects following radioembolization with glass microspheres.

Citing Articles

Extrahepatic Y Complication; Gastric Ulcer Secondary to Y Therapy for Liver Metastasis Despite Negative Preprocedural Imaging.

Shea C, Lamberg H, Turk S, Sanogo M, Turgeon D, Nojkov B Nucl Med Mol Imaging. 2024; 58(2):86-91.

PMID: 38510819 PMC: 10948730. DOI: 10.1007/s13139-023-00828-z.

Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips.

Villalobos A, Pisanie J, Gandhi R, Kokabi N Semin Intervent Radiol. 2024; 41(1):63-78.

PMID: 38495257 PMC: 10940044. DOI: 10.1055/s-0044-1779715.

A new animal model of atrophy-hypertrophy complex and liver damage following Yttrium-90 lobar selective internal radiation therapy in rabbits.

Paramo M, Santamaria E, Idoate M, Rodriguez-Fraile M, Benito A, Collantes M Sci Rep. 2022; 12(1):1777.

PMID: 35110610 PMC: 8810801. DOI: 10.1038/s41598-022-05672-3.

Recognizing and Managing Adverse Events in Y-90 Radioembolization.

Laidlaw G, Johnson G Semin Intervent Radiol. 2021; 38(4):453-459.

PMID: 34629713 PMC: 8497076. DOI: 10.1055/s-0041-1735617.

Yttrium-90 Radioembolization Dosimetry: What Trainees Need to Know.

Villalobos A, Soliman M, Majdalany B, Schuster D, Galt J, Bercu Z Semin Intervent Radiol. 2020; 37(5):543-554.

PMID: 33328711 PMC: 7732571. DOI: 10.1055/s-0040-1720954.

References

Yoon H, Oh D, Park H, Kang S, Han Y, Lim D . Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma. Strahlenther Onkol. 2013; 189(7):541-6. DOI: 10.1007/s00066-013-0343-0. View

Kao Y, Steinberg J, Tay Y, Lim G, Yan J, Townsend D . Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res. 2013; 3(1):57. PMC: 3733999. DOI: 10.1186/2191-219X-3-57. View

Song S, Chung J, Lim H, Park J . Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol. 2006; 17(3):461-9. DOI: 10.1097/01.rvi.0000202718.16416.18. View

Murthy R, Brown D, Salem R, Meranze S, Coldwell D, Krishnan S . Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy. J Vasc Interv Radiol. 2007; 18(4):553-61. DOI: 10.1016/j.jvir.2007.02.002. View

Szyszko T, Al-Nahhas A, Tait P, Rubello D, Canelo R, Habib N . Management and prevention of adverse effects related to treatment of liver tumours with 90Y microspheres. Nucl Med Commun. 2006; 28(1):21-4. DOI: 10.1097/MNM.0b013e3280121a8f. View

Yang M, Lee J, Choi M, Park H, Rhee P, Kim J . Gastrointestinal complications after radiation therapy in patients with hepatocellular carcinoma. Hepatogastroenterology. 2005; 52(66):1759-63. View

Neff R, Abdel-Misih R, Khatri J, Dignazio M, Garcia M, Petrelli N . The toxicity of liver directed yttrium-90 microspheres in primary and metastatic liver tumors. Cancer Invest. 2008; 26(2):173-7. DOI: 10.1080/07357900701512688. View

Luo D, Chan J . Basophilic round bodies in gastric biopsies little known by pathologists: iatrogenic yttrium 90 microspheres deriving from selective internal radiation therapy. Int J Surg Pathol. 2013; 21(5):535-7. DOI: 10.1177/1066896913481057. View

Mallach S, Ramp U, Erhardt A, Schmitt M, Haussinger D . An uncommon cause of gastro-duodenal ulceration. World J Gastroenterol. 2008; 14(16):2593-5. PMC: 2708377. DOI: 10.3748/wjg.14.2593. View

10.

Kennedy A, Coldwell D, Nutting C, Murthy R, Wertman Jr D, Loehr S . Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys. 2006; 65(2):412-25. DOI: 10.1016/j.ijrobp.2005.12.051. View

11.

Blanchard R, Morrow I, Sutherland J . Treatment of liver tumors with yttrium-90 microspheres alone. Can Assoc Radiol J. 1989; 40(4):206-10. View

12.

Dezarn W, Cessna J, DeWerd L, Feng W, Gates V, Halama J . Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys. 2011; 38(8):4824-45. DOI: 10.1118/1.3608909. View

13.

Bolch W, Bouchet L, ROBERTSON J, Wessels B, Siegel J, Howell R . MIRD pamphlet No. 17: the dosimetry of nonuniform activity distributions--radionuclide S values at the voxel level. Medical Internal Radiation Dose Committee. J Nucl Med. 1999; 40(1):11S-36S. View

14.

Elschot M, Vermolen B, Lam M, de Keizer B, van den Bosch M, W A M de Jong H . Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One. 2013; 8(2):e55742. PMC: 3566032. DOI: 10.1371/journal.pone.0055742. View

15.

Streitparth F, Pech M, Bohmig M, Ruehl R, Peters N, Wieners G . In vivo assessment of the gastric mucosal tolerance dose after single fraction, small volume irradiation of liver malignancies by computed tomography-guided, high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2006; 65(5):1479-86. DOI: 10.1016/j.ijrobp.2006.02.052. View

16.

Salem R, Thurston K . Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol. 2006; 17(8):1251-78. DOI: 10.1097/01.RVI.0000233785.75257.9A. View

17.

Konda A, Savin M, Cappell M, Duffy M . Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity. Gastrointest Endosc. 2009; 70(3):561-7. DOI: 10.1016/j.gie.2009.03.015. View

18.

Riaz A, Lewandowski R, Kulik L, Mulcahy M, Sato K, Ryu R . Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol. 2009; 20(9):1121-30. DOI: 10.1016/j.jvir.2009.05.030. View

19.

Garin E, Lenoir L, Rolland Y, Edeline J, Mesbah H, Laffont S . Dosimetry based on 99mTc-macroaggregated albumin SPECT/CT accurately predicts tumor response and survival in hepatocellular carcinoma patients treated with 90Y-loaded glass microspheres: preliminary results. J Nucl Med. 2012; 53(2):255-63. DOI: 10.2967/jnumed.111.094235. View

20.

Carretero C, Munoz-Navas M, Betes M, Angos R, Subtil J, Fernandez-Urien I . Gastroduodenal injury after radioembolization of hepatic tumors. Am J Gastroenterol. 2007; 102(6):1216-20. DOI: 10.1111/j.1572-0241.2007.01172.x. View