Radioembolization-Induced Chronic Hepatotoxicity: A Single-Center Cohort AnalysisClinical question
What are the delayed effects of transarterial radioembolization on the liver?
13% of patients were noted to have delayed radiation-induced hepatotoxicity with tumor involving more than 50% of the liver and cirrhosis as notable predisposing factors.
Brian M. Currie, et al. Radioembolization-Induced Chronic Hepatotoxicity: A Single-Center Cohort Analysis. Journal of Vascular and Interventional Radiology. Dec, 2019: 30; 12, 1915-1923.
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Table 6. Demographics and Treatment Details: Subset Analysis
The authors defined a classification system called radioembolization-induced chronic hepatotoxicity (RECHT) to be clinically distinct from radioembolization induced liver disease (REILD) and radiation induced liver disease (RILD). In RECHT, toxicity occurs 6 months or greater from treatment and must be permanent. Lab criteria included INR, bilirubin, ALT, AST, alkaline phosphatase, albumin, and platelets and were classified from grade 1-4 based on CTCAE classification. Clinical toxicity criteria included hepatic necrosis, hepatic failure (encephalopathy), portal hypertension (varices), ascites, and portal vein thrombosis and were classified grade 3 or 4. The authors defined RECHT as any new and permanent Grade 3 or 4 clinical and laboratory hepatotoxicity that could not be attributed to disease progression or other factors.
While 50% of patients had chronic hepatotoxicity, only 13% were classified as RECHT. The remaining were excluded due to disease progression, additional therapies complicating the clinical picture, or REILD. 92% of patients with RECHT had clinical complications. 5% of all patients and 36% of patients with RECHT died.
Using univariate and subgroup analysis, tumoral burden (greater than 50%) and cirrhosis were found to be predisposing factors for developing RECHT. Notably, patients who developed RECHT received on average a lower radiation dose.
David M Mauro, MD
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina