title: Oesophageal ulceration after selective internal radiation therapy in a patient with carcinoma of unknown primary.
abstract: BACKGROUND
  Cancer of unknown primary (CUP) is defined as histologically confirmed metastases in the absence of an identifiable primary tumor. Patients with solely liver metastases from adenocarinomas represent the most frequent subgroup with an unfavourable prognosis. The medium survival averages 6 to 9 months. No chemotherapheutic standard has been established.
  
  
  METHODS
  We present a patient with hepatic CUP. After cycles of chemotherapy and hemihepatectomy the tumor returned and showed hepatic progression. The patient was evaluated for selective internal radiation therapy (SIRT). Three years after diagnosis she is still alive and tumorfree. Despite a good result and disease control our patient suffered radiation-induced ulceration in the oesophagus, stomach, and duodenum. This side effect appears in up to 12 % of patients, often very late after treatment, is refractory to pharmacotherapy and persistent over a long time.
  
  
  CONCLUSIONS
  SIRT is a new, effective treatment in patients with hepatic CUP. Because of the anticipated increase of this therapy, adverse side effects such as ulcerations in the upper-GI tract secondary to ectopic implantation of microspheres may be seen more commonly. Awareness of this and the recognition of microspheres in biopsies is cardinal for appropriate management and maintenance of the patient's quality of life.
authors.affiliation: Gastroenterology, University of Munich. Constanze.Kubisch@med.uni-muenchen.de
authors.forename: C H
authors.initials: CH
authors.lastname: Kubisch
authors.forename: F
authors.initials: F
authors.lastname: Beigel
authors.forename: S
authors.initials: S
authors.lastname: Ihrler
authors.forename: B
authors.initials: B
authors.lastname: Goke
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.forename: R T
authors.initials: RT
authors.lastname: Hoffmann
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects*; D018450:Disease Progression; D004381:Duodenal Ulcer / Q000473:pathology*; D004386:Duodenum / Q000473:pathology / Q000528:radiation effects; D004621:Embolization, Therapeutic; D016145:Endoscopy, Digestive System; D004935:Esophageal Diseases / Q000473:pathology*; D004947:Esophagus / Q000473:pathology / Q000528:radiation effects*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000528:radiation effects; D006498:Hepatectomy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000528:radiation effects; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D008863:Microspheres; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009382:Neoplasms, Unknown Primary / Q000098:blood supply / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000473:pathology*; D018714:Radiotherapy, Adjuvant; D013276:Stomach Ulcer / Q000473:pathology*; D014456:Ulcer / Q000473:pathology*