Toxicities after Radioembolization with Yttrium-90 SIR-Spheres: Incidence and Contributing Risk Factors at a Single Center

Purpose: To report the incidence of liver function test (LFT) toxicities after radioembolization with yttrium-90 (Y-90) SIR-Spheres and review potential risk factors. Materials and Methods: Patients receiving 90Y for radioembolization of primary or metastatic liver tumors had follow-up LFTs 29-571 days after treatment. The incidence and duration of bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) toxicities were documented using common terminology criteria. Factors that were assessed included previous intra-arterial (IA) therapy, systemic chemotherapy, low tumor-to-normal liver tissue ratio at mapping angiography, vascular stasis, and higher prescribed Y-90 doses. Results: There were 81 patients who underwent 122 infusions and had follow-up LFTs. Of 122 infusions, 71(58%) were associated with toxicity. One patient died with radiation-induced liver disease. Grade 3 or greater toxicities occurred in seven (7%) patients after nine procedures. The median durations of laboratory elevations for bilirubin, AST, and ALT were 29 days, 29 days, and 20 days. Toxicity developed after 51(71%) of 72 infusions with previous IA therapy versus 20(40%) of 50 infusions in treatment-naive areas (P =.0006). Absence of previous systemic therapy was associated with greater risk of toxicity versus previous chemotherapy (47% vs 66%, P =.03). Other factors were not associated with increased toxicity. Conclusions: Mild hepatotoxicity developed frequently after infusion of SIR-Spheres using the body surface area method, with normalization of LFTs in most patients. Grade 3 or greater toxicities were seen in < 10% of infusions. Toxicity was strongly associated with previous IA therapy.