Digestive Disease Interventions 2023; 07(02): 138-144
DOI: 10.1055/s-0043-1760730
Review Article

Complications of 90Y Radioembolization Treatment for Liver Tumors

Mason Eghbali
1   Ronald Reagan UCLA Medical Center, Los Angeles, California
2   Division of Interventional Radiology, Department of Radiology, University of California Los Angeles, Los Angeles, California
,
Zachary M. Haber
1   Ronald Reagan UCLA Medical Center, Los Angeles, California
,
Ravi N. Srinivasa
1   Ronald Reagan UCLA Medical Center, Los Angeles, California
,
Siddharth A. Padia
1   Ronald Reagan UCLA Medical Center, Los Angeles, California
› Author Affiliations

Abstract

Y90 radioembolization has been demonstrated to be a safe and effective treatment for patients with HCC and for certain liver metastases, such as neuroendocrine tumors, uveal melanomas, and breast cancer. Although the procedure is relatively safe, the complications associated with radioembolization vary greatly in their locations, presentation, and severity. This review aims to discuss and increase awareness of the potential complications associated with radioembolization.



Publication History

Received: 25 October 2022

Accepted: 08 December 2022

Article published online:
27 January 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Villanueva A. Hepatocellular carcinoma. N Engl J Med 2019; 380 (15) 1450-1462
  • 2 Llovet JM, Kelley RK, Villanueva A. et al. Hepatocellular carcinoma. Nat Rev Dis Primers 2021; 7 (01) 6-33
  • 3 Singal AG, Waljee AK, Patel N. et al. Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma. J Natl Compr Canc Netw 2013; 11 (09) 1101-1108
  • 4 Zarour LR, Anand S, Billingsley KG. et al. Colorectal cancer liver metastasis: evolving paradigms and future directions. Cell Mol Gastroenterol Hepatol 2017; 3 (02) 163-173
  • 5 The Liver Transplant Process. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed August 10, 2022 at: https://www.niddk.nih.gov/health-information/liver-disease/liver-transplant/preparing-transplant
  • 6 Saini A, Wallace A, Alzubaidi S. et al. History and evolution of yttrium-90 radioembolization for hepatocellular carcinoma. J Clin Med 2019; 8 (01) 55-67
  • 7 Lewandowski RJ, Gabr A, Abouchaleh N. et al. Radiation segmentectomy: potential curative therapy for early hepatocellular carcinoma. Radiology 2018; 287 (03) 1050-1058
  • 8 Abouchaleh N, Gabr A, Ali R. et al. 90Y radioembolization for locally advanced hepatocellular carcinoma with portal vein thrombosis: long-term outcomes in a 185-patient cohort. J Nucl Med 2018; 59 (07) 1042-1048
  • 9 Salem R, Johnson GE, Kim E. et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology 2021; 74 (05) 2342-2352
  • 10 Jia Z, Wang W. Yttrium-90 radioembolization for unresectable metastatic neuroendocrine liver tumor: a systematic review. Eur J Radiol 2018; 100: 23-29
  • 11 Eldredge-Hindy H, Ohri N, Anne PR. et al. Yttrium-90 microsphere brachytherapy for liver metastases from uveal melanoma: clinical outcomes and the predictive value of fluorodeoxyglucose positron emission tomography. Am J Clin Oncol 2016; 39 (02) 189-195
  • 12 Feretis M, Solodkyy A. Yttrium-90 radioembolization for unresectable hepatic metastases of breast cancer: a systematic review. World J Gastrointest Oncol 2020; 12 (02) 228-236
  • 13 Raval M, Bande D, Pillai AK. et al. Yttrium-90 radioembolization of hepatic metastases from colorectal cancer. Front Oncol 2014; 4: 120
  • 14 Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol 2014; 4: 198
  • 15 Woerner AJ, Johnson GE. Advances in Y-90 radioembolization for the treatment of hepatocellular carcinoma. Hepatoma Res 2022; 8: 2-14
  • 16 Mascarenhas N, Ryu RK, Salem R. Erratum: hepatic radioembolization complicated by abscess. Semin Intervent Radiol 2017; 34 (03) 303-304
  • 17 Naymagon S, Warner RR, Patel K. et al. Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: an institutional experience and review of the literature. Dig Dis Sci 2010; 55 (09) 2450-2458
  • 18 Gaba RC. Planning arteriography for yttrium-90 microsphere radioembolization. Semin Intervent Radiol 2015; 32 (04) 428-438
  • 19 Veloso N, Brandão C, Gonçalves B. et al. Gastroduodenal ulceration following liver radioembolization with yttrium-90. Endoscopy 2013; 45 (Suppl 2 UCTN): E108-E109
  • 20 Laidlaw GL, Johnson GE. Recognizing and managing adverse events in Y-90 radioembolization. Semin Intervent Radiol 2021; 38 (04) 453-459
  • 21 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
  • 22 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
  • 23 Carretero C, Munoz-Navas M, Betes M. et al. Gastroduodenal injury after radioembolization of hepatic tumors. Am J Gastroenterol 2007; 102 (06) 1216-1220
  • 24 Neff R, Abdel-Misih R, Khatri J. et al. The toxicity of liver directed yttrium-90 microspheres in primary and metastatic liver tumors. Cancer Invest 2008; 26 (02) 173-177
  • 25 Topcuoglu OM, Alan Selcuk N, Sarikaya B, Toklu T. Safety of transarterial radioembolization with yttrium-90 glass microspheres without cystic artery occlusion. Radiol Med (Torino) 2019; 124 (06) 575-580
  • 26 Parakh S, Gananadha S, Allen R, Yip D. Cholecystitis after yttrium-90 resin microsphere radioembolization treatment: clinical and pathologic findings. Asian J Surg 2016; 39 (03) 144-148
  • 27 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
  • 28 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
  • 29 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
  • 30 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
  • 31 Hickey R, Lewandowski RJ. Hepatic radioembolization complicated by radiation cholecystitis. Semin Intervent Radiol 2011; 28 (02) 230-233
  • 32 Leung TW, Lau WY, Ho SK. et al. Radiation pneumonitis after selective internal radiation treatment with intraarterial 90yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys 1995; 33 (04) 919-924
  • 33 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
  • 34 Kesim S, Ones T, Eryuksel E. et al. Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report. BMC Med Imaging 2020; 20 (01) 52-56
  • 35 Wright CL, Werner JD, Tran JM. et al. Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review. J Vasc Interv Radiol 2012; 23 (05) 669-674
  • 36 Jain V, Berman AT. Radiation pneumonitis: old problem, new tricks. Cancers (Basel) 2018; 10 (07) 222-237
  • 37 Bledsoe TJ, Nath SK, Decker RH. Radiation pneumonitis. Clin Chest Med 2017; 38 (02) 201-208
  • 38 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
  • 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
  • 40 Miyayama S, Matsui O, Taki K. et al. Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 2006; 29 (01) 39-48
  • 41 Ramirez M, Ravichandran S, Ronald L. et al. Recognition and management of dermatologic complications from interventional radiology procedures. Diagn Interv Imaging 2019; 100 (11) 659-670
  • 42 Sangro B, Gil-Alzugaray B, Rodriguez J. et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 2008; 112 (07) 1538-1546
  • 43 Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol 2017; 29 (02) 144-152
  • 44 Seidensticker M, Fabritius MP, Beller J. et al. Impact of pharmaceutical prophylaxis on radiation-induced liver disease following radioembolization. Cancers (Basel) 2021; 13 (09) 1992-2004
  • 45 Benson R, Madan R, Kilambi R, Chander S. Radiation induced liver disease: a clinical update. J Egypt Natl Canc Inst 2016; 28 (01) 7-11
  • 46 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): 20200752-20200757
  • 47 Young JY, Rhee TK, Atassi B. et al. Radiation dose limits and liver toxicities resulting from multiple yttrium-90 radioembolization treatments for hepatocellular carcinoma. J Vasc Interv Radiol 2007; 18 (11) 1375-1382
  • 48 Mascarenhas NB, Mulcahy MF, Lewandowski RJ, Salem R, Ryu RK. Hepatic abscess after yttrium-90 radioembolization for islet-cell tumor hepatic metastasis. Cardiovasc Intervent Radiol 2010; 33 (03) 650-653