Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature

Manon N G J A Braat*, Sander C Ebbers, Ahmed A Alsultan, Atal O Neek, Rutger C G Bruijnen, Maarten L J Smits, Joep de Bruijne, Marnix G E H Lam*, Arthur J A T Braat*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Article number3652
JournalDiagnostics (Basel, Switzerland)
Volume13
Issue number24
DOIs
Publication statusPublished - 12 Dec 2023

Keywords

  • drug-induced liver disease
  • hepatotoxicity
  • prophylaxis
  • radioembolization

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