Table 2. Summary of Post-Y90 SIRT Complications (11,14,35,36,37,39,40,41,75).
| Complications | Findings/Conclusions | Incidence | Prevent/Treatment | ||
|---|---|---|---|---|---|
| Hepatic | Hepatic dysfunction | RILD | Hepatomegaly, ascites, jaundice, elevated serum transaminases (esp. alkaline phosphatase) | 0–4% (36, 37) | May require aggressive therapy to control symptoms from abdominal ascites |
| REILD (36) | Jaundice and ascites 1 to 2 months after RE/observed in patient that had received chemotherapy pre- or post-RE | 20% (36) | Systematically assess for liver damage 1 to 2 months after RE | ||
| Extrahepatic | GI | PRS | Nausea, vomiting, fatigue, abdominal pain/discomfort, and/or cachexia | 10–70% (14, 35) | Antiemetics for nausea, vomiting; steroids |
| GI ulcers | < 5% (41) | May prevent by coiling GDA and right gastric artery/prophylactic antacids; endoscopy to confirm | |||
| RUQ pain or generalized abdominal pain | Over-the-counter analgesics | ||||
| Diarrhea | Antidiarrheal medications; fluids and electrolyte replacement | ||||
| Biliary | Radiation cholecystitis | < 10% (39) | May prevent by coiling cystic artery | ||
| Radiation-induced cholangitis | Fever, jaundice, RUQ | May require antibiotics | |||
| Bilomas/abscess | Conservative management/percutaneous drainage | ||||
| Pancreatic | Acute pancreatitis | Severe epigastric or periumbilical pain | Very rare (14) | Conservative treatment | |
| Pulmonary | Radiation pneumonitis | May see bat-wing appearance on chest CT | < 1% (40, 75) | Recommend delivery of Y90 to lungs < 30 Gy in one treatment or accumulative dose < 50 Gy in multiple treatments (11, 40) | |
| Atelectasis and/or pleural effusion | May require steroids | ||||
| Renal | Contrast-induced nephrotoxicity | May prevent by adequate hydration pre- and post-procedure and limited use of iodinated contrast | |||
| Vascular | Vascular injury | May prevent by stopping blood thinners appropriately | |||
| Radiation dermatitis and periumbilical pain | Diffusion of microspheres in falciform artery | Rare (14) | May prevent by coiling artery | ||
| Hematology | Lymphopenia | Patients may have greater than 25% of their lymphocyte count decrease following Y90-SIRT | |||
| Thrombocytopenia | Splenomegaly may be observed | ||||
| Immunology | Allergic reaction to iodinated contrast | Range from pruritic rash to anaphylactic shock | May require anti-histamine and/or steroids |
GDA = gastroduodenal artery, GI = gastrointestinal, PRS = post-radioembolization syndrome, RE = radioembolization, REILD = radioembolization-induced liver disease, RLD = radiation-induced liver disease, RUQ = right upper quadrant, Y90-SIRT = yttrium-90 selective internal radiation therapy