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 language | English (US) |
|---|---|
| Pages (from-to) | 1520-1526 |
| Number of pages | 7 |
| Journal | Journal of Vascular and Interventional Radiology |
| Volume | 28 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2017 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
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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 journal › Article
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.
UR - http://www.scopus.com/inward/record.url?scp=85021445633&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021445633&partnerID=8YFLogxK
U2 - 10.1016/j.jvir.2017.05.011
DO - 10.1016/j.jvir.2017.05.011
M3 - Article
C2 - 28673658
AN - SCOPUS:85021445633
VL - 28
SP - 1520
EP - 1526
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
SN - 1051-0443
IS - 11
ER -