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Yttrium-90 Microsphere Treatment-Induced Gastrointestinal Ulcers in Patients With Liver Tumours Are Preventable: Presented at SIR

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- March 20, 2008 -- A retrospective review of the first 100 consecutive patients with liver malignancies treated with yttrium-90 (⁹⁰Y) microspheres indicates that cases of gastrointestinal ulcers are associated with delivery of the drug into the left hepatic artery.

Lead author Michael A. Savin, MD, Interventional Radiologist, Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan, reported the findings here at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting.

"The purpose of this study was to determine, after ⁹⁰Y microsphere treatment, the gastrointestinal ulcer rate, and patient or procedure characteristics predictive of ulcers," explained Dr. Savin in a presentation on March 16.

The review included 54 men and 46 women who had been treated consecutively from 2001 to 2007, with 62 of the patients treated in the last 2 years.

Patients were aged a median of 66 years; 48 of the patients had colorectal primary tumours, 29 had hepatomas, and the remainder had a variety of other primary tumours, among them neuroendocrine, breast, lung, or oesophageal cancers.

For the study, the researchers analysed procedure characteristics that might predispose patients to ulcerations, specifically whether or not gastrointestinal branches were embolised, whether use of the microspheres influenced ulceration rate, and which arteries were treated, indicated Dr. Savin.

"A meticulous angiographic technique was used to identify extrahepatic arteries, and embolisation of gastrointestinal arteries was performed if significant risk of ⁹⁰Y microspheres floating in the gastrointestinal tract was present," said Dr. Savin. If the risk was low, the embolisation was not necessarily performed, he added.

Technetium-99m macroaggregated albumin scans were taken in all patients to identify residual nontarget organ activity. If the test was positive, repeat angiogram, repeat embolisation, and repeat scans were performed.

Sixty-two patients had embolisations of gastrointestinal arteries and many had embolisation of multiple arteries, for a total of 162 embolisation procedures, said Dr. Savin.

Thirteen patients had endoscopies. Microsphere-induced gastrointestinal ulcerations occurred in 6 patients, with onset at 2 weeks to 4 months. The 6 patients with ulcerations had gastrointestinal bleeding, 2 had dyspepsia, and 1 had haematemesis.

The most common ulcer location was the stomach, followed by the duodenum and the distal oesophagus. All these patients had ulcer-causing microspheres in their gastrointestinal system, said Dr. Savin.

Ulcers were treated with proton pump inhibitor therapy; the ulcer persisted in the dyspepsia patients.

"So, what patient characteristics could predict ulcers? The answer is none, at least not age, gender, or the cancer type," said Dr. Savin. The only statistically significant parameter was the type of artery treated with ⁹⁰Y microspheres, he added.

A total of 173 arteries were infused. For 74 infusions into the right hepatic artery, there was only 1 case of ulcer (<1%), while for 47 infusions in the left hepatic artery there were 5 cases of ulcer (11%), a statistically significant difference (P = .037), "likely due to right gastric artery arising from the left hepatic artery," he explained.

Dr. Savin emphasised the importance of rigorous technique to limit cases of nontarget embolisation, because gastrointestinal ulcers are clearly associated with left hepatic artery deliveries.


[Presentation title: Gastrointestinal Ulcerations in 100 Consecutive Patients Treated With Y90 Microspheres: Rate and Associations. Abstract 28]

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