Radiation microsphere–induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity - 23/08/11
Reprint requests: Amulya Konda, MD, 3601 West 13 Mile Road, Royal Oak, MI 48073.Royal Oak, Michigan, USA
Abstract |
Background |
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.
Objectives |
Clinically and pictorially characterize selective internal radiation therapy (SIRT)–induced GI injury and review the published literature.
Design |
Retrospective chart analysis.
Setting |
Single-center tertiary referral community hospital.
Patients |
One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008.
Interventions |
SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients.
Outcome Measures |
GI ulcers after SIRT.
Results |
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.
Limitations |
Small retrospective study and follow-up limited by terminal disease states in most patients.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : PPI, SIR, SIRT, SPECT, TcMAA, Y-90
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 70 - N° 3
P. 561-567 - septembre 2009 Retour au numéro
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