Gastroduodenal ulceration after selective internal radiation therapy of liver tumor

Wallstabe, I.; Bakos, G.; Plötner, Andreas; Kretzschmar, Albrecht; Wegner, Danilo; Hohdorf, K.; Scheibe, J

doi:10.1055/s-0032-1310023

Cited by 3 publications

(6 citation statements)

References 2 publications

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“…Recurrent GI hemorrhage can be managed by direct endoscopic therapy or selective bland targeted arterial embolization. Rarely (<10% of cases), perforation or bleeding may require surgical excision of the involved GI tract segment with bypass …”

Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

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Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

et al. 2017

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Selective internal radiation therapy (or radioembolization) by intra-arterial injection of radioactive yttrium-90-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high-dose beta-radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off-target diversion of yttrium-90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization-induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (Hepatology 2017;66:969-982).

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Section: Gastrointestinal Ulcerationsmentioning

confidence: 99%

“…Rarely (<10% of cases), perforation or bleeding may require surgical excision of the involved GI tract segment with bypass. (24,25) Liver Complications…”

Section: Treatment Of Gi Ulcerationsmentioning

confidence: 99%

Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

et al. 2017

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“…If symptoms persist, a jejunostomy may be required until the ulcer is healed [10]. In a small number of cases (<10%), surgery may be required to rectify perforation, bleeding or pain [18,30,31].…”

Section: Therapeutic Measuresmentioning

confidence: 99%

“…Radioactive microspheres, loaded with the beta-emitting radioisotope 90yttrium (90Y), are delivered by intra-arterial hepatic injection. There are two types of microspheres used to carry 90Y, glass microspheres, which are [20][21][22][23][24][25][26][27][28][29][30] μm in size, and resin microspheres, which are 20-40 μm in size.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, pathophysiology, and treatment of SIRT-induced gastroduodenal ulcers: A systematic literature review

Belcaid¹,

Vinciane

Vouche

et al. 2020

Surgical Oncology

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Background: Selective Internal Radiation Therapy (SIRT) is a therapeutic modality in patients with hepatocellular carcinoma or liver metastases. Complications due to SIRT-induced gastric ulcers are seen in less than 5% of patients but there is no consensus for management of this rare side effect. We conducted a systematic review to analyze the efficacy of medical treatment of SIRT-induced ulcers. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. We developed the research question following the population, intervention, comparison, outcome, and study design (PICOS) format. We identified studies and cases reporting patients with gastric and/or duodenal (=population) ulcers treated with medical therapy with proton pump inhibitor (PPI), antacid, or sucralfate, alone or in combination (=intervention). We did not require that studies include a control group. We included studies reporting the evaluation of the medical and/or surgical treatment (=outcomes). Results: Out of 219 articles, 29 articles were included, resulting in analysis of data for a total of 51 patients who had a SIRT-induced gastric and/or duodenal ulcer treated with medication, surgery, or both. Twenty-eight patients (55%) were reported to have SIRT-induced ulcers that improved after initiation of PPI, antacid, or sucralfate treatment (alone or in combination). Twenty-three patients (45%) were reported to be refractory to medical treatment and surgery was performed in 7 out of 23 patients (30%). Conclusions: About 45% of SIRT-induced gastroduodenal ulcers are refractory to medical treatment with PPI, antacid, or sucralfate, alone or in combination. Surgery is an effective treatment in patients who are refractory to medical treatment and who have intense symptoms.

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“…Prior publications consist of either solitary case reports or limited series of up to 5 patients. [5][6][7][8][9][10] The primary purpose of this study is to assess the pathologic sequela of biopsy-proven gastrointestinal injury secondary to Y90 therapy in a larger multi-institutional cohort. Furthermore, as most of the published cases of pathologically confirmed gastrointestinal injury due to Y90 appear to be associated with resin microspheres, we sought to identify any differences in the incidence and features of gastrointestinal injury between resin-based and glass-based Y90 spheres.…”

mentioning

confidence: 99%

Gastrointestinal Tract Injury by Yttrium-90 Appears Largely Restricted to Resin Microspheres But Can Occur Years After Embolization

Feely¹,

Tondon

Gubbiotti

et al. 2022

American Journal of Surgical Pathology

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Radioembolization therapy utilizes yttrium-90 (Y90) impregnated resin (SIR-Spheres) or glass (TheraSpheres) microspheres to selectively target hepatic lesions via transarterial radioembolization. Occasional cases of gastrointestinal tract injury, secondary to nontargeted delivery of microspheres, have been reported, but large descriptive pathology series are lacking. We identified 20 cases of histologically confirmed mucosal injury associated with Y90 from 17 patients and assessed the corresponding clinical and pathologic sequelae. The mucosal biopsies were obtained from 1 to 88 months following Y90 therapy (median: 5 mo). Most cases were gastric (17, 85%), while the remaining were duodenal. Endoscopic ulceration was seen in the majority of cases (16, 80%), and mucosal erythema in the remaining 4. Histologically, a majority (19, 95%) of cases showed rounded, dark blue to purple microspheres measuring 4 to 30 µm, consistent with resin microspheres. A single case with glass microspheres demonstrated 26 µm translucent beads. Histologic evidence of ulceration was appreciated in 14 (70%) cases, and the microspheres were clearly intravascular in 6 (30%). A foreign body giant cell reaction to the microspheres was uncommon (3 cases, 15%). We additionally performed a retrospective review of all gastrointestinal tissue obtained postprocedure from 784 sequential patients treated with Y90 microspheres. Three patients (0.4%) demonstrated the presence of resin microspheres upon histologic examination. No cases involving glass-based Y90 were identified (P=0.0078), despite the majority of patients having received glass radioembolization (630, 80%). This increased risk of secondary sphere dissemination is likely related to the increased number of particles required per activity for resin versus glass microspheres. We conclude that Y90 microspheres may be encountered in the gastrointestinal tract years after initial liver-targeted therapy and, when present, are often associated with mucosal ulceration. This finding is less likely to be encountered in patients who received Y90 radioembolization utilizing glass microspheres.

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Gastroduodenal ulceration after selective internal radiation therapy of liver tumor

Cited by 3 publications

References 2 publications

Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review

Diagnosis, pathophysiology, and treatment of SIRT-induced gastroduodenal ulcers: A systematic literature review

Gastrointestinal Tract Injury by Yttrium-90 Appears Largely Restricted to Resin Microspheres But Can Occur Years After Embolization

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