Safety of yttrium-90 microsphere radioembolization in patients with biliary obstruction

Ron C. Gaba, Ahsun Riaz, Robert J Lewandowski, Saad M. Ibrahim, Robert K. Ryu, Kent T Sato, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

PURPOSE: There are few data on radioembolization in the setting of biliary obstruction. The present study was performed to assess the safety of yttrium-90 (90Y) radioembolization in the setting of tumor-related biliary obstruction and total bilirubin levels of 2 mg/dL or lower. MATERIALS AND METHODS: Twelve patients with liver tumors underwent 19 treatment sessions with 90Y to the obstructed liver lobe or segment. Initial bilirubin level was 2 mg/dL or lower in all cases. Measured outcomes included pre-and posttreatment white blood cell (WBC) count, total bilirubin level, and alkaline phosphatase (ALP) level. Bilirubin toxicities and biliary complications were assessed according to Common Toxicity Criteria, version 3.0. RESULTS: Lobar or segmental 90Y was successful in all cases. Pre-and posttreatment median WBC counts (5.3 vs 5.3; P =.490), bilirubin levels (1.0 vs 1.1; P =.460), and ALP levels (195 vs 146; P =.712) showed no differences. One case of grade 3 bilirubin toxicity was noted in a patient with liver hilar nodal progression and subsequent biliary obstruction requiring external drainage. Complete resolution of biliary obstruction was seen after 90Y treatment in one case of metastatic colorectal carcinoma at 1 month follow-up. No biliary complications (infection, sepsis, biliary necrosis, biloma formation, abscess development, or biliary stricture) were encountered in this cohort during an overall median follow-up time of 22.9 months. CONCLUSIONS: The use of 90Y glass microspheres demonstrated a good safety profile in the setting of tumor-related biliary obstruction in patients with normal or near-normal bilirubin levels in this series, without evidence of therapy-related progressive leukocytosis, bilirubin increase, or infectious or biliary complications after treatment.

Original languageEnglish (US)
Pages (from-to)1213-1218
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume21
Issue number8
DOIs
StatePublished - Jul 5 2010

Fingerprint

Yttrium
Microspheres
Bilirubin
Safety
Leukocyte Count
Alkaline Phosphatase
Liver
Neoplasms
Leukocytosis
Therapeutics
Abscess
Glass
Drainage
Colorectal Neoplasms
Sepsis
Pathologic Constriction
Necrosis

Keywords

  • ALP
  • HCC
  • WBC
  • alkaline phosphatase
  • hepatocellular carcinoma
  • white blood cell

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{35aefe3d9ceb48ed9f04b31d949f0c4f,
title = "Safety of yttrium-90 microsphere radioembolization in patients with biliary obstruction",
abstract = "PURPOSE: There are few data on radioembolization in the setting of biliary obstruction. The present study was performed to assess the safety of yttrium-90 (90Y) radioembolization in the setting of tumor-related biliary obstruction and total bilirubin levels of 2 mg/dL or lower. MATERIALS AND METHODS: Twelve patients with liver tumors underwent 19 treatment sessions with 90Y to the obstructed liver lobe or segment. Initial bilirubin level was 2 mg/dL or lower in all cases. Measured outcomes included pre-and posttreatment white blood cell (WBC) count, total bilirubin level, and alkaline phosphatase (ALP) level. Bilirubin toxicities and biliary complications were assessed according to Common Toxicity Criteria, version 3.0. RESULTS: Lobar or segmental 90Y was successful in all cases. Pre-and posttreatment median WBC counts (5.3 vs 5.3; P =.490), bilirubin levels (1.0 vs 1.1; P =.460), and ALP levels (195 vs 146; P =.712) showed no differences. One case of grade 3 bilirubin toxicity was noted in a patient with liver hilar nodal progression and subsequent biliary obstruction requiring external drainage. Complete resolution of biliary obstruction was seen after 90Y treatment in one case of metastatic colorectal carcinoma at 1 month follow-up. No biliary complications (infection, sepsis, biliary necrosis, biloma formation, abscess development, or biliary stricture) were encountered in this cohort during an overall median follow-up time of 22.9 months. CONCLUSIONS: The use of 90Y glass microspheres demonstrated a good safety profile in the setting of tumor-related biliary obstruction in patients with normal or near-normal bilirubin levels in this series, without evidence of therapy-related progressive leukocytosis, bilirubin increase, or infectious or biliary complications after treatment.",
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author = "Gaba, {Ron C.} and Ahsun Riaz and Lewandowski, {Robert J} and Ibrahim, {Saad M.} and Ryu, {Robert K.} and Sato, {Kent T} and Omary, {Reed A.} and Riad Salem",
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Safety of yttrium-90 microsphere radioembolization in patients with biliary obstruction. / Gaba, Ron C.; Riaz, Ahsun; Lewandowski, Robert J; Ibrahim, Saad M.; Ryu, Robert K.; Sato, Kent T; Omary, Reed A.; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 21, No. 8, 05.07.2010, p. 1213-1218.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Safety of yttrium-90 microsphere radioembolization in patients with biliary obstruction

AU - Gaba, Ron C.

AU - Riaz, Ahsun

AU - Lewandowski, Robert J

AU - Ibrahim, Saad M.

AU - Ryu, Robert K.

AU - Sato, Kent T

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2010/7/5

Y1 - 2010/7/5

N2 - PURPOSE: There are few data on radioembolization in the setting of biliary obstruction. The present study was performed to assess the safety of yttrium-90 (90Y) radioembolization in the setting of tumor-related biliary obstruction and total bilirubin levels of 2 mg/dL or lower. MATERIALS AND METHODS: Twelve patients with liver tumors underwent 19 treatment sessions with 90Y to the obstructed liver lobe or segment. Initial bilirubin level was 2 mg/dL or lower in all cases. Measured outcomes included pre-and posttreatment white blood cell (WBC) count, total bilirubin level, and alkaline phosphatase (ALP) level. Bilirubin toxicities and biliary complications were assessed according to Common Toxicity Criteria, version 3.0. RESULTS: Lobar or segmental 90Y was successful in all cases. Pre-and posttreatment median WBC counts (5.3 vs 5.3; P =.490), bilirubin levels (1.0 vs 1.1; P =.460), and ALP levels (195 vs 146; P =.712) showed no differences. One case of grade 3 bilirubin toxicity was noted in a patient with liver hilar nodal progression and subsequent biliary obstruction requiring external drainage. Complete resolution of biliary obstruction was seen after 90Y treatment in one case of metastatic colorectal carcinoma at 1 month follow-up. No biliary complications (infection, sepsis, biliary necrosis, biloma formation, abscess development, or biliary stricture) were encountered in this cohort during an overall median follow-up time of 22.9 months. CONCLUSIONS: The use of 90Y glass microspheres demonstrated a good safety profile in the setting of tumor-related biliary obstruction in patients with normal or near-normal bilirubin levels in this series, without evidence of therapy-related progressive leukocytosis, bilirubin increase, or infectious or biliary complications after treatment.

AB - PURPOSE: There are few data on radioembolization in the setting of biliary obstruction. The present study was performed to assess the safety of yttrium-90 (90Y) radioembolization in the setting of tumor-related biliary obstruction and total bilirubin levels of 2 mg/dL or lower. MATERIALS AND METHODS: Twelve patients with liver tumors underwent 19 treatment sessions with 90Y to the obstructed liver lobe or segment. Initial bilirubin level was 2 mg/dL or lower in all cases. Measured outcomes included pre-and posttreatment white blood cell (WBC) count, total bilirubin level, and alkaline phosphatase (ALP) level. Bilirubin toxicities and biliary complications were assessed according to Common Toxicity Criteria, version 3.0. RESULTS: Lobar or segmental 90Y was successful in all cases. Pre-and posttreatment median WBC counts (5.3 vs 5.3; P =.490), bilirubin levels (1.0 vs 1.1; P =.460), and ALP levels (195 vs 146; P =.712) showed no differences. One case of grade 3 bilirubin toxicity was noted in a patient with liver hilar nodal progression and subsequent biliary obstruction requiring external drainage. Complete resolution of biliary obstruction was seen after 90Y treatment in one case of metastatic colorectal carcinoma at 1 month follow-up. No biliary complications (infection, sepsis, biliary necrosis, biloma formation, abscess development, or biliary stricture) were encountered in this cohort during an overall median follow-up time of 22.9 months. CONCLUSIONS: The use of 90Y glass microspheres demonstrated a good safety profile in the setting of tumor-related biliary obstruction in patients with normal or near-normal bilirubin levels in this series, without evidence of therapy-related progressive leukocytosis, bilirubin increase, or infectious or biliary complications after treatment.

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KW - hepatocellular carcinoma

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