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Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review
Author(s) -
Sangro Bruno,
MartínezUrbistondo Diego,
Bester Lourens,
Bilbao Jose I.,
Coldwell Douglas M.,
Flamen Patrick,
Kennedy Andrew,
Ricke Jens,
Sharma Ricky A.
Publication year - 2017
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29207
Subject(s) - medicine , selective internal radiation therapy , radiation therapy , hepatology , surgical oncology , intensive care medicine , radiology , medical physics , hepatocellular carcinoma
Selective internal radiation therapy (or radioembolization) by intra‐arterial injection of radioactive yttrium‐90‐loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high‐dose beta‐radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off‐target diversion of yttrium‐90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization‐induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (H epatology 2017;66:969–982).