Download PDF
Semin intervent Radiol 2021; 38(04): 453-459
DOI: 10.1055/s-0041-1735617
Review Article

Recognizing and Managing Adverse Events in Y-90 Radioembolization

Grace L. Laidlaw
1   Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
,
Guy E. Johnson
1   Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Transarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.

Keywords

radioembolization - Y-90 - toxicity - complications - interventional radiology


Publication History

Article published online:
07 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Salem R, Lewandowski RJ, Kulik L. et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 2011; 140 (02) 497-507.e2
    CrossrefPubMedSearch in Google Scholar
  • 2 Zhang Y, Li Y, Ji H, Zhao X, Lu H. Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: a meta-analysis. Biosci Trends 2015; 9 (05) 289-298
    CrossrefPubMedSearch in Google Scholar
  • 3 Chow PKH, Gandhi M, Tan SB. et al; Asia-Pacific Hepatocellular Carcinoma Trials Group. SIRveNIB: selective internal radiation therapy versus sorafenib in Asia-Pacific patients with hepatocellular carcinoma. J Clin Oncol 2018; 36 (19) 1913-1921
    CrossrefPubMedSearch in Google Scholar
  • 4 Salem R, Gilbertsen M, Butt Z. et al. Increased quality of life among hepatocellular carcinoma patients treated with radioembolization, compared with chemoembolization. Clin Gastroenterol Hepatol 2013; 11 (10) 1358-1365.e1
    CrossrefPubMedSearch in Google Scholar
  • 5 Gil-Alzugaray B, Chopitea A, Iñarrairaegui M. et al. Prognostic factors and prevention of radioembolization-induced liver disease. Hepatology 2013; 57 (03) 1078-1087
    CrossrefPubMedSearch in Google Scholar
  • 6 Kennedy AS, McNeillie P, Dezarn WA. et al. Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys 2009; 74 (05) 1494-1500
    CrossrefPubMedSearch in Google Scholar
  • 7 van Hazel GA, Heinemann V, Sharma NK. et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol 2016; 34 (15) 1723-1731
    CrossrefPubMedSearch in Google Scholar
  • 8 Padia SA, Lewandowski RJ, Johnson GE. et al; Society of Interventional Radiology Standards of Practice Committee. Radioembolization of hepatic malignancies: background, quality improvement guidelines, and future directions. J Vasc Interv Radiol 2017; 28 (01) 1-15
    CrossrefPubMedSearch in Google Scholar
  • 9 Bester L, Meteling B, Pocock N. et al. Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol 2012; 23 (01) 96-105
    CrossrefPubMedSearch in Google Scholar
  • 10 Su YK, Mackey RV, Riaz A. et al. Long-term hepatotoxicity of yttrium-90 radioembolization as treatment of metastatic neuroendocrine tumor to the liver. J Vasc Interv Radiol 2017; 28 (11) 1520-1526
    CrossrefPubMedSearch in Google Scholar
  • 11 Tomozawa Y, Jahangiri Y, Pathak P. et al. Long-term toxicity after transarterial radioembolization with yttrium-90 using resin microspheres for neuroendocrine tumor liver metastases. J Vasc Interv Radiol 2018; 29 (06) 858-865
    CrossrefPubMedSearch in Google Scholar
  • 12 Badar W, Van Ha T, Zangan S. et al. Safety and efficacy of repeat Y90 radioembolization to the same hepatic arterial territory. Br J Radiol 2021; 94 (1119): 20200752
    CrossrefPubMedSearch in Google Scholar
  • 13 Currie BM, Hoteit MA, Ben-Josef E, Nadolski GJ, Soulen MC. Radioembolization-induced chronic hepatotoxicity: a single-center cohort analysis. J Vasc Interv Radiol 2019; 30 (12) 1915-1923
    CrossrefPubMedSearch in Google Scholar
  • 14 Salem R, Johnson GE, Kim E. et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable hepatocellular carcinoma: the LEGACY study. Hepatology 2021; ;(epub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 15 Sangro B, Martínez-Urbistondo D, Bester L. et al. Prevention and treatment of complications of selective internal radiation therapy: expert guidance and systematic review. Hepatology 2017; 66 (03) 969-982
    CrossrefPubMedSearch in Google Scholar
  • 16 Buettner S, Braat AJAT, Margonis GA. et al. Yttrium-90 radioembolization in intrahepatic cholangiocarcinoma: a multicenter retrospective analysis. J Vasc Interv Radiol 2020; 31 (07) 1035-1043.e2
    CrossrefPubMedSearch in Google Scholar
  • 17 Cholapranee A, van Houten D, Deitrick G. et al. Risk of liver abscess formation in patients with prior biliary intervention following yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2015; 38 (02) 397-400
    CrossrefPubMedSearch in Google Scholar
  • 18 Devulapalli KK, Fidelman N, Soulen MC. et al. 90Y radioembolization for hepatic malignancy in patients with previous biliary intervention: multicenter analysis of hepatobiliary infections. Radiology 2018; 288 (03) 774-781
    CrossrefPubMedSearch in Google Scholar
  • 19 Khan W, Sullivan KL, McCann JW. et al. Moxifloxacin prophylaxis for chemoembolization or embolization in patients with previous biliary interventions: a pilot study. AJR Am J Roentgenol 2011; 197 (02) W343-W345
    CrossrefPubMedSearch in Google Scholar
  • 20 Dezarn WA, Cessna JT, DeWerd LA. et al; American Association of Physicists in Medicine. 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 (08) 4824-4845
    CrossrefPubMedSearch in Google Scholar
  • 21 Gates VL, Hickey R, Marshall K. et al. Gastric injury from (90)Y to left hepatic lobe tumors adjacent to the stomach: fact or fiction?. Eur J Nucl Med Mol Imaging 2015; 42 (13) 2038-2044
    CrossrefPubMedSearch in Google Scholar
  • 22 Wright GP, Marsh JW, Varma MK, Doherty MG, Bartlett DL, Chung MH. Liver resection after selective internal radiation therapy with yttrium-90 is safe and feasible: a bi-institutional analysis. Ann Surg Oncol 2017; 24 (04) 906-913
    CrossrefPubMedSearch in Google Scholar
  • 23 Gabr A, Abouchaleh N, Ali R. et al. Outcomes of surgical resection after radioembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2018; 29 (11) 1502-1510.e1
    CrossrefPubMedSearch in Google Scholar
  • 24 McDonald S, Rubin P, Phillips TL, Marks LB. Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys 1995; 31 (05) 1187-1203
    CrossrefPubMedSearch in Google Scholar
  • 25 Claude L, Pérol D, Ginestet C. et al. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis. Radiother Oncol 2004; 71 (02) 175-181
    CrossrefPubMedSearch in Google Scholar
  • 26 Salem R, Parikh P, Atassi B. et al. Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol 2008; 31 (05) 431-438
    CrossrefPubMedSearch in Google Scholar
  • 27 Das A, Riaz A, Gabr A. et al. Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort. Eur J Nucl Med Mol Imaging 2020; 47 (04) 807-815
    CrossrefPubMedSearch in Google Scholar
  • 28 Gaba RC, Vanmiddlesworth KA. Chemoembolic hepatopulmonary shunt reduction to allow safe yttrium-90 radioembolization lobectomy of hepatocellular carcinoma. Cardiovasc Intervent Radiol 2012; 35 (06) 1505-1511
    CrossrefPubMedSearch in Google Scholar
  • 29 Ward TJ, Tamrazi A, Lam MG. et al. Management of high hepatopulmonary shunting in patients undergoing hepatic radioembolization. J Vasc Interv Radiol 2015; 26 (12) 1751-1760
    CrossrefPubMedSearch in Google Scholar
  • 30 Thüring J, Zimmermann M, Bruners P. et al. Short-term oral sorafenib for therapy of intratumoral shunts of hepatocellular carcinoma to enable intraarterial treatment. Cardiovasc Intervent Radiol 2019; 42 (10) 1494-1499
    CrossrefPubMedSearch in Google Scholar
  • 31 Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med 2017; 38 (02) 201-208
    CrossrefPubMedSearch in Google Scholar
  • 32 Henriksson R, Bergström P, Franzén L, Lewin F, Wagenius G. Aspects on reducing gastrointestinal adverse effects associated with radiotherapy. Acta Oncol 1999; 38 (02) 159-164
    CrossrefPubMedSearch in Google Scholar
  • 33 Collins J, Salem R. Hepatic radioembolization complicated by gastrointestinal ulceration. Semin Intervent Radiol 2011; 28 (02) 240-245
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Lam MGEH, Banerjee S, Louie JD. et al. Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2013; 36 (06) 1536-1547
    CrossrefPubMedSearch in Google Scholar
  • 35 Kallini JR, Gabr A, Thorlund K. et al. Comparison of the adverse event profile of TheraSphere® with SIR-Spheres® for the treatment of unresectable hepatocellular carcinoma: a systematic review. Cardiovasc Intervent Radiol 2017; 40 (07) 1033-1043
    CrossrefPubMedSearch in Google Scholar
  • 36 Murthy R, Brown DB, Salem R. et al. Gastrointestinal complications associated with hepatic arterial yttrium-90 microsphere therapy. J Vasc Interv Radiol 2007; 18 (04) 553-561 , quiz 562
    CrossrefPubMedSearch in Google Scholar
  • 37 Padia SA, Johnson GE, Lewandowski RJ, Gabr A, Toskich BB. Transarterial yttrium-90 radioembolization of hepatocellular carcinoma perfused by the cystic artery: multi-institutional feasibility study. J Vasc Interv Radiol 2020; 31 (12) 2022-2027
    CrossrefPubMedSearch in Google Scholar
  • 38 Powerski M, Busse A, Seidensticker M. et al. Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies–an evaluation of necessity. Cardiovasc Intervent Radiol 2015; 38 (03) 678-684
    CrossrefPubMedSearch in Google Scholar
  • 39 Leong QM, Lai HK, Lo RG, Teo TK, Goh A, Chow PK. Radiation dermatitis following radioembolization for hepatocellular carcinoma: a case for prophylactic embolization of a patent falciform artery. J Vasc Interv Radiol 2009; 20 (06) 833-836
    CrossrefPubMedSearch in Google Scholar
  • 40 Wang DS, Louie JD, Kothary N, Shah RP, Sze DY. Prophylactic topically applied ice to prevent cutaneous complications of nontarget chemoembolization and radioembolization. J Vasc Interv Radiol 2013; 24 (04) 596-600
    CrossrefPubMedSearch in Google Scholar
  • 41 Riaz A, Lewandowski RJ, Kulik LM. et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009; 20 (09) 1121-1130 , quiz 1131
    CrossrefPubMedSearch in Google Scholar
  • 42 Alexander ES, Pantel AR, Carlin SD. et al. Prospective study of systemic yttrium-90 elution during radioembolization of hepatic metastases. J Vasc Interv Radiol 2020; 31 (12) 2007-2013.e1
    CrossrefPubMedSearch in Google Scholar