Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity.
BACKGROUND
Intra-arterial infusion of yttrium-90 (Y-90) microspheres is locoregional radiation therapy for unresectable hepatic neoplasms. Literature on GI complications of this novel therapy is sparse.


OBJECTIVE
Clinically and pictorially characterize selective internal radiation therapy (SIRT)-induced GI injury and review the published literature.


METHODS
Retrospective chart analysis.


METHODS
Single-center tertiary referral community hospital.


METHODS
One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008.


METHODS
SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients.


METHODS
GI ulcers after SIRT.


RESULTS
Five patients with suspected GI injury after SIRT were identified. Significant postprocedural symptoms included nausea/vomiting, odynophagia, hematemesis, and melena. Radiation ulcers occurred mostly in the gastric antrum, pylorus, and duodenum. Biopsy specimens of ulcer margins in 4 patients showed pathognomonic radiation microspheres. Angiographic review of the fifth patient revealed a previously unrecognized arterial branch supplying the corresponding region of GI ulceration noted on endoscopy.


CONCLUSIONS
Small retrospective study and follow-up limited by terminal disease states in most patients.


CONCLUSIONS
The reported incidence of GI complications after SIRT for hepatic neoplasia varies from 3% to 24% of patients. Incidence can be minimized by strict adherence to published SIRT protocols. Diagnosis requires a high degree of clinical suspicion along with endoscopy and biopsy of ulcer margins. Characteristic radiation microspheres in biopsy specimens are pathognomonic. Gastroenterologists and pathologists must be cognizant of this complication.
Konda
Amulya
A
Department of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Savin
Michael A
MA
Cappell
Mitchell S
MS
Duffy
Michael C
MC
D000328:Adult; D000368:Aged; D000792:Angiography; D004307:Dose-Response Relationship, Radiation; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004384:Duodenoscopy; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005773:Gastroscopy; D006499:Hepatic Artery; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D012494:Sampling Studies; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D019452:Terminally Ill; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use
D015021:Yttrium Radioisotopes