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Gastric injury from 90Y to left hepatic lobe tumors adjacent to the stomach: fact or fiction?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Radioembolization with 90Y microspheres is a locoregional radiation therapy for unresectable hepatic neoplasm. Non-target delivery of 90Y microspheres resulting in gastrointestinal (GI) symptoms is a recognized complication; there is minimal knowledge regarding the radiation effect to the gastric wall from left hepatic lobe 90Y treatments. Our aim was to study the incidence of GI complications when the target tissue (hepatic parenchyma ± tumor) is in close proximity to the gastric wall. We hypothesized that liver (tumor) to stomach proximity does not correlate with increased toxicity.

Methods

Between November 2011 and September 2013, we studied all patients who underwent left lobe radioembolization with 90Y glass microspheres. With Institutional Review Board (IRB) approval, we retrospectively reviewed MRI/CT images of these patients, identifying a subset of patients with the left hepatic lobe <1 cm from the gastric wall. Patients were seen in clinic 1 month posttreatment and subsequently at 3-month intervals. Short- and long-term gastric adverse events were tabulated.

Results

Ninety-seven patients successfully underwent left hepatic lobe 90Y microsphere radioembolization in which the average distance from the liver to the stomach wall was 1.0 ± 2.8 mm. The average dose for patients who received radioembolization to the left hepatic lobe was 109 ± 57 Gy. Fifty patients had tumor within 1 cm of the gastric wall. The average dose for patients who received radioembolization to the left hepatic lobe with tumor within 1 cm of the gastric wall was 121 ± 41 Gy. There were no reportable or recordable medical events. Of the patients, 34 % reported abdominal pain that was grade 1–2; 65 % of the patients reported no abdominal pain. None of the 97 patients developed a clinically evident GI ulcer.

Conclusion

Patients with left lobe tumors adjacent to or abutting the stomach do not exhibit acute or chronic radiation effects following radioembolization with glass microspheres.

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Compliance with ethical standards

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Role of funding

There was no funding provided for this study.

Conflicts of interest

RJL and RS are advisors to BTG. The other authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Vanessa L. Gates, Ryan Hickey, Karen Marshall, Melissa Williams, Krystina Salzig, Robert J. Lewandowski & Riad Salem

  2. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Riad Salem

Authors
  1. Vanessa L. Gates
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  2. Ryan Hickey
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  3. Karen Marshall
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  4. Melissa Williams
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  5. Krystina Salzig
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  6. Robert J. Lewandowski
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  7. Riad Salem
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Correspondence to Riad Salem.

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Gates, V.L., Hickey, R., Marshall, K. et al. Gastric injury from 90Y to left hepatic lobe tumors adjacent to the stomach: fact or fiction?. Eur J Nucl Med Mol Imaging 42, 2038–2044 (2015). https://doi.org/10.1007/s00259-015-3122-6

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  • DOI: https://doi.org/10.1007/s00259-015-3122-6

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