title: Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity.
abstract: 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.
authors: Department of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, Michigan, USA.
authors: Amulya
authors: A
authors: Konda
authors: Michael A
authors: MA
authors: Savin
authors: Mitchell S
authors: MS
authors: Cappell
authors: Michael C
authors: MC
authors: Duffy
mesh_terms: 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
chemical_list: D015021:Yttrium Radioisotopes