Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review
Sangro B (1,2), Martínez-Urbistondo D (1), Bester L (3), Bilbao JI (4), Coldwell DM (5), Flamen P (6), Kennedy A (7), Ricke J (8), Sharma RA (9).
(1) Liver Unit, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
(2) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Pamplona Spain.
(3) Department of Interventional Radiology, University of New South Wales St. Vincent's Hospital, Darlinghurst, Australia.
(4) Department of Radiology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
(5) James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.
(6) Department of Nuclear Medicine, Jules Bordet Institute, Brussels, Belgium.
(7) Physician-in-Chief, Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN, USA.
(8) Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany.
(9) University College London, UCL Cancer Institute, London, UK.
Selective internal radiation therapy (SIRT or radioembolisation) by intraarterial injection of radioactive yttrium-90 (90 Y)-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer.
The high-dose beta-radiation penetrates an average of only 2.5 mm from the source so that its effects are limited to the site of delivery. However the off-target diversion of 90 Y microspheres to tissues other than the tumor may lead to complications.
The most prominent ones include: radiation gastritis and gastrointestinal (GI) ulcers, cholecystitis, radiation pneumonitis, and radioembolisation-induced liver disease (REILD).
Complications may occur despite careful pre-treatment planning and SIRT demands an expert multidisciplinary team (MDT) approach in order to provide comprehensive care for patients. This review provides recommendations to MDTs on the optimal medical processes in order to ensure the safe delivery of SIRT.
Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis and management of potential radiation injury to the liver and to other organs.
CITATION Hepatology. 2017 Apr 13. doi: 10.1002/hep.29207