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  • Title: Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity.
    Author: Konda A, Savin MA, Cappell MS, Duffy MC.
    Journal: Gastrointest Endosc; 2009 Sep; 70(3):561-7. PubMed ID: 19577743.
    Abstract:
    BACKGROUND: Intra-arterial infusion of yttrium-90 (Y-90) microspheres is locoregional radiation therapy for unresectable hepatic neoplasms. Literature on GI complications of this novel therapy is sparse. OBJECTIVES: Clinically and pictorially characterize selective internal radiation therapy (SIRT)-induced GI injury and review the published literature. DESIGN: Retrospective chart analysis. SETTING: Single-center tertiary referral community hospital. PATIENTS: One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008. INTERVENTIONS: SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients. OUTCOME MEASURES: GI ulcers after SIRT. RESULTS: Five patients with suspected GI injury after SIRT were identified. Significant postprocedural symptoms included nausea/vomiting, odynophagia, hematemesis, and melena. Radiation ulcers occurred mostly in the gastric antrum, pylorus, and duodenum. Biopsy specimens of ulcer margins in 4 patients showed pathognomonic radiation microspheres. Angiographic review of the fifth patient revealed a previously unrecognized arterial branch supplying the corresponding region of GI ulceration noted on endoscopy. LIMITATIONS: Small retrospective study and follow-up limited by terminal disease states in most patients. CONCLUSIONS: The reported incidence of GI complications after SIRT for hepatic neoplasia varies from 3% to 24% of patients. Incidence can be minimized by strict adherence to published SIRT protocols. Diagnosis requires a high degree of clinical suspicion along with endoscopy and biopsy of ulcer margins. Characteristic radiation microspheres in biopsy specimens are pathognomonic. Gastroenterologists and pathologists must be cognizant of this complication.
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