Radiation‐induced Ulceration of the Stomach Secondary to Hepatic Embolization With Radioactive Yttrium Microspheres in the Treatment of Metastatic Colon Cancer

Yip, Desmond; Allen, Robert; Ashton, Christopher; Jain, Sanjiv

doi:10.1111/j.1440-1746.2003.03322.x

Cited by 65 publications

(33 citation statements)

References 6 publications

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“…In about 15% of patients, vessels too small to be detected on an angiogram may pass from the liver to the gut (22). Radiation and diminished blood supply due to embolization by the spheres and subsequent hypoxia may result in ulceration and even perforation of the stomach and duodenum (10,23). 90 Y-induced ulceration of the stomach or duodenum can be resistant to medical therapy, and surgery may be required (8).…”

Section: Discussionmentioning

confidence: 99%

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The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment

Ahmadzadehfar¹,

Sabet²,

Biermann³

et al. 2010

J Nucl Med

116

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Selective internal radiation therapy (SIRT), a catheter-based liver-directed modality for treating primary and metastatic liver cancer, requires appropriate planning to maximize its therapeutic response and minimize its side effects. 99m Tc-macroaggregated albumin (MAA) scanning should precede the therapy to detect any extrahepatic shunting to the lung or gastrointestinal tract. Our aim was to compare the ability of SPECT/CT with that of planar imaging and SPECT in the detection and localization of extrahepatic 99m Tc-MAA accumulation and to evaluate the impact of SPECT/CT on SIRT treatment planning and its added value to angiography in this setting. Methods: Ninety diagnostic hepatic angiograms with 99m Tc-MAA were obtained for 76 patients with different types of cancer. All images were reviewed retrospectively for extrahepatic MAA deposition in the following order: planar, non-attenuation-corrected SPECT, and SPECT/CT. Review of angiograms and follow-up of patients with abdominal shunting served as reference standards. Results: Extrahepatic accumulation was detected by planar imaging, SPECT, and SPECT/CT in 12%, 17%, and 42% of examinations, respectively. The sensitivity for detecting extrahepatic shunting with planar imaging, SPECT, and SPECT/CT was 32%, 41%, and 100%, respectively; specificity was 98%, 98%, and 93%, respectively. The respective positive predictive values were 92%, 93%, and 89%, and the respective negative predictive values were 71%, 73%, and 100%. The therapy plan was changed according to the results of planar imaging, SPECT, and SPECT/CT in 7.8%, 8.9%, and 29% of patients, respectively. Conclusion: In pre-SIRT planning, 99m Tc-MAA SPECT/CT is valuable for identifying extrahepatic visceral sites at risk for postradioembolization complications.

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Section: Discussionmentioning

confidence: 99%

“…Serious complications have been reported when microspheres were inadvertently deposited in excessive amounts in organs other than the liver. Reported complications include gastrointestinal ulceration or bleeding, gastritis or duodenitis, cholecystitis, pancreatitis, and radiation pneumonitis (1,2,(6)(7)(8)(9)(10)(11).…”

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confidence: 99%

The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment

Ahmadzadehfar¹,

Sabet²,

Biermann³

et al. 2010

J Nucl Med

116

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“…The reasons for aberrant implantation are often collaterals that are arising from the hepatic arteries distal to the therapy position or branching close to the therapy position with an extra-hepatic communication. Radiation and diminished blood supply due to non-target embolization may result in ischemia and inflammation leading to ulceration or even perforation of the stomach or duodenum, or in cholecystitis or pancreatitis [16,32]. Therefore, up to now, it is recommended to protect potential aberrant vessels like the gastroduodenal artery by coil embolization even if they are proximal to the therapy position.…”

Section: Introductionmentioning

confidence: 99%

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

Paprottka

Walter

et al. 2015

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety of radioembolization (RE) with 90 Yttrium ( 90 Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. Materials and MethodsEarly and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group). Results Clinically relevant late toxicities (CGrade 3) were observed in 1 % of our overall cohort. The no-coiling group had significantly less ''any'' (P = 0.0001) or ''clinically relevant'' (P = 0.0003) early toxicity. There was no significant difference (P [ 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures. Conclusion RE with 90 Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.

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“…Reported side effects of Y-90 microsphere treatment are pulmonary fibrosis, gastroduodenal ulcer and radiation cholecystitis [23][24][25][26][27][28]. These adverse effects are caused by extrahepatic leakage of Y-90 microspheres.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

Kim

et al. 2010

Nucl Med Mol Imaging

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Purpose Y-90 resin microsphere radioembolization is used to treat inoperable hepatic tumors. After injection of Y-90 resin microsphere, the only method to visualize the distribution of Y-90 is the scintigraphic imaging of bremsstrahlung radiation. The purpose of this study was to evaluate the characteristics and usefulness of bremsstrahlung imaging in Y-90 resin microsphere treatment. Methods Twenty patients (22 administrations) underwent intra-arterial Y-90 resin microsphere treatment. For pretreatment planning, images of Tc-99m albumin macroaggregate (MAA) arterial injection and hepatic contrast angiography were obtained. Post-treatment bremsstrahlung images were taken and compared with pre-treatment images. The extrahepatic activity was evaluated on bremsstrahlung images. To correlate the size and vascularity of the tumors with tumor visualization on bremsstrahlung images, the individual tumors were grouped according to visualization on each image and compared with one another by size and tumor-to-normal ratio. Results All post-therapeutic bremsstrahlung images showed similar contours of the liver with pre-treatment angiography. No extrahepatic activity was seen in all cases. The visualized tumors on bremsstrahlung images were significantly larger than the non-visualized tumors. Tumor-to-normal ratios of the visualized tumors on bremsstrahlung images were significantly higher than those of the non-visualized tumors. Conclusions Bremsstrahlung images after intra-arterial Y-90 resin microsphere treatment are useful in evaluating the intrahepatic distribution of radioisotope and detecting possible extrahepatic activity.

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Radiation‐induced Ulceration of the Stomach Secondary to Hepatic Embolization With Radioactive Yttrium Microspheres in the Treatment of Metastatic Colon Cancer

Cited by 65 publications

References 6 publications

The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment

The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment

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

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

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Radiation‐induced Ulceration of the Stomach Secondary to Hepatic Embolization With Radioactive Yttrium Microspheres in the Treatment of Metastatic Colon Cancer

Cited by 65 publications

References 6 publications

The Significance of 99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for 90Y-Microsphere Selective Internal Radiation Treatment

The Significance of 99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for 90Y-Microsphere Selective Internal Radiation Treatment

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

Usefulness of Bremsstrahlung Images after Intra-arterial Y-90 Resin Microphere Radioembolization for Hepatic Tumors

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The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment

The Significance of ^99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for ⁹⁰Y-Microsphere Selective Internal Radiation Treatment