Liver disease induced by radioembolization of liver tumors: description and possible risk factors.
BACKGROUND
To the authors' knowledge, liver damage after liver radioembolization with yttrium90-labeled microspheres has never been studied specifically.


METHODS
Using a complete set of data recorded prospectively among all patients without previous chronic liver disease treated by radioembolization at the authors' institution from September 2003 to July 2006, patterns of liver damage were identified and possible risk factors were analyzed.


RESULTS
In all, 20% of patients developed a distinct clinical picture that appeared 4 to 8 weeks after treatment and was characterized by jaundice and ascites. Veno-occlusive disease was the histologic hallmark observed in the most severe cases. This form of sinusoidal obstruction syndrome was not observed among patients who never received chemotherapy or in those in whom a single hepatic lobe was treated. Relevant to treatment planning, a possible risk factor was a higher treatment dose in relation to the targeted liver volume. A transjugular intrahepatic stent shunt improved liver function in 2 patients with impending liver failure, although 1 of them eventually died from it.


CONCLUSIONS
Radioembolization of liver tumors, particularly after antineoplastic chemotherapy, may result in an uncommon but potentially life-threatening form of hepatic sinusoidal obstruction syndrome that presents clinically with jaundice and ascites.
Sangro
Bruno
B
Liver Unit, Department of Internal Medicine, University Clinic and CIBERHD, Pamplona, Spain. bsangro@unav.es
Gil-Alzugaray
Belen
B
Rodriguez
Javier
J
Sola
Iosu
I
Martinez-Cuesta
Antonio
A
Viudez
Antonio
A
Chopitea
Ana
A
Iñarrairaegui
Mercedes
M
Arbizu
Javier
J
Bilbao
Jose I
JI
D000328:Adult; D017024:Chemotherapy, Adjuvant; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008099:Liver / Q000528:radiation effects*; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology* / Q000628:therapy; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D012307:Risk Factors; D015021:Yttrium Radioisotopes / Q000009:adverse effects
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes