Radiation microsphere–induced GI ulcers after selective internal radiation therapy for hepatic tumors: an underrecognized clinical entity

BackgroundIntra-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.ObjectivesClinically and pictorially characterize selective internal radiation therapy (SIRT)–induced GI injury and review the published literature.DesignRetrospective chart analysis.SettingSingle-center tertiary referral community hospital.PatientsOne hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008.InterventionsSIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients.Outcome MeasuresGI ulcers after SIRT.ResultsFive 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.LimitationsSmall retrospective study and follow-up limited by terminal disease states in most patients.ConclusionsThe 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.