Interventional Oncology - Avoiding Common Pitfalls to Reduce Toxicity in Hepatic Radioembolization

David M Liu, David Cade, Darre

Abstract

Within the setting of hepatic neoplasia [primary and secondary], selective internal radiation therapy [SIRT], also known as radioembolization has become an accepted procedure, incorporated into the armamentarium of multidisciplinary oncologic care. The procedure itself requires understanding of mesenteric anatomy, tumor vascular patterns, liver metabolism, and chemotherapy. Given the complex nature of the treatment, unique toxicities, and complications may develop from multiple etiologies. Reduction of toxicities and complications as they relate to this procedure can be stratified into two broad categories: factors involving vascularity/vascularization, and factors involving compromise to the underlying liver parenchyma. The purpose of this manuscript is to provide the reader with a systematic review of the most commonly presented toxicities, their etiologies, prevention strategies, and suggested therapeutic options in a practical, and concise manner. A brief discussion on the common misconceptions regarding toxicities will be included.