Long-Term Hepatotoxicity of Yttrium-90 Radioembolization as Treatment of Metastatic Neuroendocrine Tumor to the Liver

Yu Kai Su, Rosewell V. Mackey, Ahsun Riaz, Vanessa L. Gates, Al B Benson III, Frank H Miller, Vahid Yaghmai, Ahmed Gabr, Riad Salem, Robert J Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Purpose To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P =.023) and lower albumin levels (P =.0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity. Conclusions Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients.

Original languageEnglish (US)
Pages (from-to)1520-1526
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume28
Issue number11
DOIs
StatePublished - Nov 1 2017

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Yttrium
Neuroendocrine Tumors
Liver
Fibrosis
Therapeutics
Portal Hypertension
Varicose Veins
Platelet Count
Microspheres
Ascites
Glass
Pancreas
Albumins

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{9351f587dfb6436ca7bd100b9974b1e4,
title = "Long-Term Hepatotoxicity of Yttrium-90 Radioembolization as Treatment of Metastatic Neuroendocrine Tumor to the Liver",
abstract = "Purpose To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7{\%} (4 of 15), ascites in 13.3{\%} (2 of 15), varices in 6.7{\%} (1 of 15), and a 21.9{\%} increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4{\%} (22 of 39), 41.0{\%} (16 of 39), and 15.4{\%} (6 of 39), with a 64.7{\%} increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P =.023) and lower albumin levels (P =.0002). Eight patients (20.5{\%}) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1{\%}) had no other causes of hepatotoxicity. Conclusions Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50{\%} of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients.",
author = "Su, {Yu Kai} and Mackey, {Rosewell V.} and Ahsun Riaz and Gates, {Vanessa L.} and {Benson III}, {Al B} and Miller, {Frank H} and Vahid Yaghmai and Ahmed Gabr and Riad Salem and Lewandowski, {Robert J}",
year = "2017",
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doi = "10.1016/j.jvir.2017.05.011",
language = "English (US)",
volume = "28",
pages = "1520--1526",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
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Long-Term Hepatotoxicity of Yttrium-90 Radioembolization as Treatment of Metastatic Neuroendocrine Tumor to the Liver. / Su, Yu Kai; Mackey, Rosewell V.; Riaz, Ahsun; Gates, Vanessa L.; Benson III, Al B; Miller, Frank H; Yaghmai, Vahid; Gabr, Ahmed; Salem, Riad; Lewandowski, Robert J.

In: Journal of Vascular and Interventional Radiology, Vol. 28, No. 11, 01.11.2017, p. 1520-1526.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Hepatotoxicity of Yttrium-90 Radioembolization as Treatment of Metastatic Neuroendocrine Tumor to the Liver

AU - Su, Yu Kai

AU - Mackey, Rosewell V.

AU - Riaz, Ahsun

AU - Gates, Vanessa L.

AU - Benson III, Al B

AU - Miller, Frank H

AU - Yaghmai, Vahid

AU - Gabr, Ahmed

AU - Salem, Riad

AU - Lewandowski, Robert J

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Purpose To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P =.023) and lower albumin levels (P =.0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity. Conclusions Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients.

AB - Purpose To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function. Results Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P =.023) and lower albumin levels (P =.0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity. Conclusions Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients.

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