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Erschienen in:
01.12.2015 | Original Article
Gastric injury from 90Y to left hepatic lobe tumors adjacent to the stomach: fact or fiction?
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 13/2015
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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.