Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: an institutional experience and review of the literature.
BACKGROUND
Microsphere radioembolization is a method of delivering radiation therapy directly to tumors, thereby minimizing toxicity to adjacent structures. Despite the relatively high precision of this modality, numerous adverse effects have been recognized. One particularly untoward complication is the development of severe gastroduodenal ulceration.


METHODS
In order to further characterize gastroduodenal ulceration associated with radioembolization, our institutional experience as well as the reported literature were reviewed.


RESULTS
The current evidence suggests that radioembolization-associated gastroduodenal ulceration results from inadvertent delivery of microspheres to the microvasculature of the gastrointestinal tract, leading to direct radiation toxicity. The reported incidence of this entity ranges between 2.9% and 4.8%. Most patients with this complication present with abdominal pain, often associated with nausea, vomiting, and anorexia. Symptoms can arise from hours to months after radioembolization treatment; diagnosis is made by endoscopic biopsy and histopathologic evaluation of the ulcer specimen. Radiation-induced ulcers have proven to be extremely difficult to treat. Current therapy based on acid suppression has had limited success, and the evidence for the addition of antioxidants and anti-inflammatory agents is still sparse.


CONCLUSIONS
The increasing utilization of radioembolization will lead to adverse events including gastroduodenal ulceration. This entity must be considered in any patient treated with radioactive microspheres presenting with symptoms of dyspepsia. Accurate diagnosis and aggressive treatment are necessary to improve patient outcomes.
Naymagon
Steven
S
Department of Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA. steven.naymagon@mssm.edu
Warner
Richard R P
RR
Patel
Kalpesh
K
Harpaz
Noam
N
Machac
Josef
J
Weintraub
Joshua L
JL
Kim
Michelle K
MK
D000818:Animals; D000975:Antioxidants / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008863:Microspheres; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects*
D000975:Antioxidants; D054328:Proton Pump Inhibitors; D015021:Yttrium Radioisotopes