Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres

Bassel Atassi, Affaan K. Bangash, Robert J. Lewandowski, Saad Ibrahim, Laura Kulik, Mary F. Mulcahy, Ravi Murthy, Robert K. Ryu, Kent T. Sato, Frank H. Miller, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Purpose: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. Materials and Methods: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. Results: A total of 327 patients (HCC, n = 190; liver metastases, n = 137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n = 26; HCC, n = 7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n = 17), biloma (n = 3), cholecystitis (n = 2), gallbladder wall enhancement (n = 6), gallbladder wall rent (n = 3), abscess (n = 1), and stricture (n = 8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). Conclusions: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.

Original languageEnglish (US)
Pages (from-to)691-697
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume19
Issue number5
DOIs
StatePublished - May 1 2008

Fingerprint

Yttrium
Microspheres
Hepatocellular Carcinoma
Liver
Neoplasm Metastasis
Gallbladder
Bilirubin
Therapeutics
Cholecystitis
Liver Function Tests
Biliary Tract
Liver Neoplasms
Clinical Protocols
Abscess
Liver Diseases
Pathologic Constriction
Necrosis
Tomography
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{92a7a6cfba79402fbbf3804d99d1b03e,
title = "Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres",
abstract = "Purpose: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. Materials and Methods: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. Results: A total of 327 patients (HCC, n = 190; liver metastases, n = 137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1{\%}; liver metastases, n = 26; HCC, n = 7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n = 17), biloma (n = 3), cholecystitis (n = 2), gallbladder wall enhancement (n = 6), gallbladder wall rent (n = 3), abscess (n = 1), and stricture (n = 8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8{\%}] with HCC, 18 [13.1{\%}] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8{\%}). Conclusions: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.",
author = "Bassel Atassi and Bangash, {Affaan K.} and Lewandowski, {Robert J.} and Saad Ibrahim and Laura Kulik and Mulcahy, {Mary F.} and Ravi Murthy and Ryu, {Robert K.} and Sato, {Kent T.} and Miller, {Frank H.} and Omary, {Reed A.} and Riad Salem",
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Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres. / Atassi, Bassel; Bangash, Affaan K.; Lewandowski, Robert J.; Ibrahim, Saad; Kulik, Laura; Mulcahy, Mary F.; Murthy, Ravi; Ryu, Robert K.; Sato, Kent T.; Miller, Frank H.; Omary, Reed A.; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 19, No. 5, 01.05.2008, p. 691-697.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres

AU - Atassi, Bassel

AU - Bangash, Affaan K.

AU - Lewandowski, Robert J.

AU - Ibrahim, Saad

AU - Kulik, Laura

AU - Mulcahy, Mary F.

AU - Murthy, Ravi

AU - Ryu, Robert K.

AU - Sato, Kent T.

AU - Miller, Frank H.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Purpose: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. Materials and Methods: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. Results: A total of 327 patients (HCC, n = 190; liver metastases, n = 137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n = 26; HCC, n = 7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n = 17), biloma (n = 3), cholecystitis (n = 2), gallbladder wall enhancement (n = 6), gallbladder wall rent (n = 3), abscess (n = 1), and stricture (n = 8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). Conclusions: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.

AB - Purpose: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. Materials and Methods: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. Results: A total of 327 patients (HCC, n = 190; liver metastases, n = 137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n = 26; HCC, n = 7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n = 17), biloma (n = 3), cholecystitis (n = 2), gallbladder wall enhancement (n = 6), gallbladder wall rent (n = 3), abscess (n = 1), and stricture (n = 8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). Conclusions: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.

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