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

doi:10.3390/diagnostics13243652

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 journal › Article › Academic › peer-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 language	English
Article number	3652
Journal	Diagnostics
Volume	13
Issue number	24
DOIs	https://doi.org/10.3390/diagnostics13243652
Publication status	Published - 12 Dec 2023

Keywords

drug-induced liver disease
hepatotoxicity
prophylaxis
radioembolization

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diagnostics-13-03652-v2Final published version, 558 KBLicence: CC BY

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Braat, M. N. G. J. A., Ebbers, S. C., Alsultan, A. A., Neek, A. O., Bruijnen, R. C. G., Smits, M. L. J., de Bruijne, J., Lam, M. G. E. H., & Braat, A. J. A. T. (2023). Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature. Diagnostics, 13(24), Article 3652. https://doi.org/10.3390/diagnostics13243652

@article{249f1919ef064f59a2f7ab5cb5924d9c,

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

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.",

keywords = "drug-induced liver disease, hepatotoxicity, prophylaxis, radioembolization",

author = "Braat, \{Manon N G J A\} and Ebbers, \{Sander C\} and Alsultan, \{Ahmed A\} and Neek, \{Atal O\} and Bruijnen, \{Rutger C G\} and Smits, \{Maarten L J\} and \{de Bruijne\}, Joep and Lam, \{Marnix G E H\} and Braat, \{Arthur J A T\}",

note = "Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = dec,

day = "12",

doi = "10.3390/diagnostics13243652",

language = "English",

volume = "13",

journal = "Diagnostics",

issn = "2075-4418",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "24",

}

Braat, MNGJA, Ebbers, SC, Alsultan, AA, Neek, AO, Bruijnen, RCG, Smits, MLJ , de Bruijne, J , Lam, MGEH & Braat, AJAT 2023, 'Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature', Diagnostics, vol. 13, no. 24, 3652. https://doi.org/10.3390/diagnostics13243652

Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature. / Braat, Manon N G J A; Ebbers, Sander C; Alsultan, Ahmed A et al.
In: Diagnostics, Vol. 13, No. 24, 3652, 12.12.2023.

Research output: Contribution to journal › Article › Academic › peer-review

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

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 - https://www.scopus.com/pages/publications/85180706875

U2 - 10.3390/diagnostics13243652

DO - 10.3390/diagnostics13243652

M3 - Article

C2 - 38132236

SN - 2075-4418

VL - 13

JO - Diagnostics

JF - Diagnostics

IS - 24

M1 - 3652

ER -

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

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