Radioembolization-Induced Chronic Hepatotoxicity: A Single-Center Cohort Analysis |
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Authors: | Brian M. Currie Maarouf A. Hoteit Edgar Ben-Josef Gregory J. Nadolski Michael C. Soulen |
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Affiliation: | 1. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104;2. Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104;3. Department of Radiation Oncology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 |
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Abstract: | PurposeTo identify and characterize the delayed effects of transarterial radioembolization (TARE) on the liver.Materials and MethodsA single-institution retrospective analysis was undertaken of all patients who received TARE between 2005 and 2014 and survived at least 1 year from the initial TARE (n = 106). Patients were evaluated for the presence or absence of radioembolization-induced chronic hepatotoxicity (RECHT) occurring at least 6 months after TARE. The mean age of patients was 63 years of age, and the malignancy most commonly treated was neuroendocrine tumor (54%). Adjudication of hepatic decompensation to RECHT versus alternative causes was performed by a multidisciplinary panel of specialists from hepatology, radiation oncology, and interventional radiology.ResultsEight patients were excluded from analysis because of liver transplantation (2) or incomplete data (6). RECHT occurred in 13 of 98 patients (13%), and 5 deaths (5%) occurred from hepatic decompensation. There were a total of 69 toxicity events in patients developing RECHT. The most common events were elevation of alkaline phosphatase (10), decrease in serum albumin (10), and development of ascites (9). RECHT patients had a higher intrahepatic tumor volume (P = .021) and a higher number of hepatic comorbidities leading to cirrhosis (P = .015).ConclusionsDelayed radiation-induced hepatic toxicity occurred in 13% of patients following radioembolization, with 5 fatalities adjudicated to be a result of the treatment. Tumor involvement of greater than 50% of the liver and cirrhosis were predisposing factors for RECHT. |
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Keywords: | ECOG Eastern Cooperative Oncology Group LDT liver-directed therapy NET neuroendocrine tumor RECHT radioembolization-induced chronic hepatotoxicity REILD radioembolization-induced liver disease RILD radiation-induced liver disease TAE transarterial embolization TARE transarterial radioembolization |
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