title: Biliary complications associated with selective internal radiation (SIR) therapy for unresectable liver malignancies.
abstract: Selective internal radiation (SIR) therapy using 90yttrium microspheres is effective for treating selected cases of unresectable liver malignancies with little morbidity. We herein report two cases illustrating a very rare complication of SIR. A 68-year-old patient with inoperable recurrent hepatocellular carcinoma received one treatment of SIR with 90yttrium microspheres and 4 months later presented with obstructive jaundice. Percutaneous transhepatic cholangiography revealed diffusely dilated intrahepatic ducts with multiple biliary strictures. Hepatic angiography showed normal hepatic arterial branches with no evidence of vascular insufficiency. Liver biopsy finally revealed cholestasis, cholangitis, and fibrosis, consistent with radiation-induced damage. Another 56-year-old patient with unresectable colorectal liver metastases presented with cholangitis 4 weeks after SIR. Ultrasonography showed no biliary dilatation, and endoscopic retrograde cholangiopancreatography demonstrated a normal biliary tree. Liver biopsy subsequently confirmed radiation-induced cholangitis.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. simonng@surgery.cuhk.edu.hk
authors.forename: Simon S M
authors.initials: SS
authors.lastname: Ng
authors.forename: Simon C H
authors.initials: SC
authors.lastname: Yu
authors.forename: Paul B S
authors.initials: PB
authors.lastname: Lai
authors.forename: W Y
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D015021:Yttrium Radioisotopes
chemical_list: D015021:Yttrium Radioisotopes