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. 2023 Dec 12;13(24):3652.
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  1 , Sander C Ebbers  1 , Ahmed A Alsultan  1 , Atal O Neek  1 , Rutger C G Bruijnen  1 , Maarten L J Smits  1 , Joep de Bruijne  2 , Marnix G E H Lam  1 , Arthur J A T Braat  1
Affiliations

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 et al. Diagnostics (Basel). .

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 (Dh). Logistic regression models were used to investigate if variables (among which are P/UDCA and Dh) 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. Dh 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.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies: BTG/Boston Scientific, Terumo and Quirem. A.J.A.T.B. is a speaker for BTG/Boston Scientific and Terumo. M.G.E.H.L. receives research support from Terumo, Quirem and Boston Scientific and is a consultant on their behalf. M.L.J.S. is a consultant for Quirem, Terumo and Philips. A.A.A. is a speaker for BTG/Boston Scientific. The department of Radiology and Nuclear Medicine of the University Medical Center Utrecht receives royalty payments from Quirem. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Figure 1
Figure 1
Literature search.
See this image and copyright information in PMC

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