Z Gastroenterol 2019; 57(11): 1304-1308
DOI: 10.1055/a-1016-3698
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Chronic gastric ulcer disease complicating selective internal radiation therapy (SIRT) in a patient with cholangiocellular carcinoma

SIRT induzierte chronische gastroduodenale Vaskulopathie
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz
,
Iva Brcic
2   Institute of Pathology, Medical University of Graz
,
Werner Jaschke
3   Department of Radiology, Medical University of Innsbruck
,
Dietmar Öfner
4   Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck
,
Peter Fickert
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz
,
Johannes Plank
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz
› Author Affiliations
Further Information

Publication History

28 April 2019

19 September 2019

Publication Date:
18 November 2019 (online)

Abstract

Selective internal radiation therapy (SIRT) is a therapeutic option for primary and metastatic liver tumors. Microspheres containing Yttrium 90, a beta-emitting radionuclide, are administered into the hepatic artery allowing selective internal radiation of a liver tumor. SIRT-related complications may appear due to migration of the radiation microspheres to organs distant from the tumor site. In order to prevent these complications, unintended non target embolization of Yttrium microspheres has to be avoided. However, data from external-beam radiation therapy (EBRT) suggests that the stomach/small bowel may actually be less radiosensitive than the liver. Gastric ulcers, a well-known SIRT-related complication, may therefore not only be caused by local radiation but also by unusual accumulation of microspheres in the submucosa and small vessel damage. We herein report a more than two- year-long persisting, highly symptomatic, non-neoplastic ulceration of the gastric antrum leading to pyloric stenosis caused by SIRT therapy with Yttrium 90 microspheres for the treatment of intrahepatic cholangiocellular carcinoma. The chronic courses of the ulcer disease together with the specific histological features highlight the pivotal role of radiation-induced small vessel damage in SIRT-induced adverse events.

Zusammenfasung

Die „Selective internal radiation therapy“ (SIRT) ist eine therapeutische Option für primäre und sekundäre Lebertumoren. Mikrosphären, die Yttrium 90, ein beta-emittierendes Radionuklid beinhalten, werden direkt in die Leberarterie appliziert, wodurch eine interne Bestrahlung des Malignoms möglich wird. SIRT-bedingte Komplikationen können auf Grund einer Dislokation der Mikrosphären in andere Organe auftreten. Um diesen Komplikationen vorzubeugen, muss eine unselektive Applikation dieser Yttrium-Mikrosphären verhindert werden, obwohl Daten der externen Strahlentherapie (EBRT) nahe legen, dass Magen und Dünndarm tatsächlich weniger strahlungssensitiv als die Leber sind. Ulcera ventriculi, eine bekannte SIRT-bedingte Komplikation, dürften daher nicht nur durch örtliche Radiatio verursacht werden, sondern auch durch Akkumulation von Mikrosphären in der Submucosa und durch Schäden an kleinen Gefäßen. Wir berichten über mehr als zwei Jahre lang persistierende, hochsymptomatische, nicht neoplastische Ulcera ventriculi mit Pylorusstenose, welche durch Yttrium 90-Mikrosphären zur Behandlung eines intrahepatischen cholangiozellulären Karzinoms verursacht wurden. Der chronische Verlauf der Ulkuskrankheit zusammen mit den spezifischen histologischen Merkmalen unterstreichen die zentrale Rolle strahleninduzierter Gefäßschäden bei SIRT.

 
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