TY - JOUR
T1 - Prophylactic Medication during Radioembolization in Metastatic Liver Disease
T2 - Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature
AU - Braat, Manon N G J A
AU - Ebbers, Sander C
AU - Alsultan, Ahmed A
AU - Neek, Atal O
AU - Bruijnen, Rutger C G
AU - Smits, Maarten L J
AU - de Bruijne, Joep
AU - Lam, Marnix G E H
AU - Braat, Arthur J A T
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/12/12
Y1 - 2023/12/12
N2 - PURPOSE: Trans-arterial radioembolization is a well-studied tumoricidal treatment for liver malignancies; however, consensus and evidence regarding periprocedural prophylactic medication (PPM) are lacking.METHODS: A single-center retrospective analysis from 2014 to 2020 was performed in patients treated with
90Y-glass microspheres for neuroendocrine or colorectal liver metastases. Inclusion criteria were the availability of at least 3 months of clinical, biochemical, and imaging follow-up and post-treatment
90Y-PET/CT imaging for the determination of the whole non-tumorous liver absorbed dose (D
h). Logistic regression models were used to investigate if variables (among which are P/UDCA and D
h) were associated with either clinical toxicity, biochemical toxicity, or hepatotoxicity. Additionally, a structured literature search was performed in November 2022 to identify all publications related to PPM use in radioembolization treatments.
RESULTS: Fifty-one patients received P/UDCA as post-treatment medication, while 19 did not. No correlation was found between toxicity and P/UDCA use. D
h was associated with biochemical toxicity (
p = 0.05). A literature review resulted in eight relevant articles, including a total of 534 patients, in which no consistent advice regarding PPM was provided.
CONCLUSION: In this single-center, retrospective review, P/UDCA use did not reduce liver toxicity in patients with metastatic liver disease. The whole non-tumorous liver-absorbed dose was the only significant factor for hepatotoxicity. No standardized international guidelines or supporting evidence exist for PPM in radioembolization.
AB - PURPOSE: Trans-arterial radioembolization is a well-studied tumoricidal treatment for liver malignancies; however, consensus and evidence regarding periprocedural prophylactic medication (PPM) are lacking.METHODS: A single-center retrospective analysis from 2014 to 2020 was performed in patients treated with
90Y-glass microspheres for neuroendocrine or colorectal liver metastases. Inclusion criteria were the availability of at least 3 months of clinical, biochemical, and imaging follow-up and post-treatment
90Y-PET/CT imaging for the determination of the whole non-tumorous liver absorbed dose (D
h). Logistic regression models were used to investigate if variables (among which are P/UDCA and D
h) were associated with either clinical toxicity, biochemical toxicity, or hepatotoxicity. Additionally, a structured literature search was performed in November 2022 to identify all publications related to PPM use in radioembolization treatments.
RESULTS: Fifty-one patients received P/UDCA as post-treatment medication, while 19 did not. No correlation was found between toxicity and P/UDCA use. D
h was associated with biochemical toxicity (
p = 0.05). A literature review resulted in eight relevant articles, including a total of 534 patients, in which no consistent advice regarding PPM was provided.
CONCLUSION: In this single-center, retrospective review, P/UDCA use did not reduce liver toxicity in patients with metastatic liver disease. The whole non-tumorous liver-absorbed dose was the only significant factor for hepatotoxicity. No standardized international guidelines or supporting evidence exist for PPM in radioembolization.
KW - drug-induced liver disease
KW - hepatotoxicity
KW - prophylaxis
KW - radioembolization
UR - http://www.scopus.com/inward/record.url?scp=85180706875&partnerID=8YFLogxK
U2 - 10.3390/diagnostics13243652
DO - 10.3390/diagnostics13243652
M3 - Article
C2 - 38132236
SN - 2075-4418
VL - 13
JO - Diagnostics (Basel, Switzerland)
JF - Diagnostics (Basel, Switzerland)
IS - 24
M1 - 3652
ER -