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.