title: Biliary sequelae following radioembolization with Yttrium-90 microspheres.
abstract: OBJECTIVE
  Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases.
  
  
  METHODS
  All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted.
  
  
  RESULTS
  A total of 327 patients (HCC, n=190; liver metastases, n=137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n=26; HCC, n=7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n=17), biloma (n=3), cholecystitis (n=2), gallbladder wall enhancement (n=6), gallbladder wall rent (n=3), abscess (n=1), and stricture (n=8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%).
  
  
  CONCLUSIONS
  90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, 676 North St. Clair Street, Suite 800, Chicago, Illinois 60611, USA.
authors.forename: Bassel
authors.initials: B
authors.lastname: Atassi
authors.forename: Affaan K
authors.initials: AK
authors.lastname: Bangash
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Saad
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Ravi
authors.initials: R
authors.lastname: Murthy
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D001659:Biliary Tract / Q000528:radiation effects*; D001663:Bilirubin / Q000032:analysis; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008863:Microspheres; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; D001663:Bilirubin