Long-term follow-up study of gastroduodenal lesions after radioembolization of hepatic tumors

Table 1 Patient and treatment characteristics

Patient	Age (yr)	Primary tumor	Concomitant treatment	Gastroduodenal artery embolization	Site of injection	Gastrointestinal activity on 99Tcm-MAA scan	Dose administrated	Pain during infusion
1	60	Colorectal	FOLFOX	Yes	Common hepatic artery	No	75%	Yes
2	39	Pancreatic NET	No	No	Left hepatic artery	No	100%	No
3	53	Ileal carcinoid	No	Yes	Proper hepatic artery	No	100%	Yes
4	65	Cholangiocarcinoma	GEMOX	No	Right and left hepatic artery	No	75%	Yes
5	54	Renal	No	Yes	Proper hepatic artery	No	100%	Yes
6	48	Colorectal	No	Yes	Proper hepatic artery	No	60%	Yes

99Tcm-MAA scan: ⁹⁹Tc-radiolabeled macroaggregated albumin; FOLFOX: Folinic acid, fluorouracil and oxaliplatin; GEMOX: Gemcitabine and oxaliplatine; NET: Neuroendocrine tumour.

Table 2 Endoscopic and histologic findings

Patient	Time from RE to first endoscopy (wk)	Findings in first endoscopy (CTCAE 4.02 grading scale)	Histology	Endoscopic follow-up time (mo)	Total number of endoscopies	Endoscopic treatment
1	6	Ulcers in cisura angularis and gastric antrum (20 mm); Multiple erosions in duodenal bulb (2)	Microspheres in lamina propia;No H. pylori bacilli	No	1	No
2	5	Severe mucositis in gastric fundus, body and antrum, with mucosal friability and superficial ulcers (2)	Microspheres; No H. pylori bacilli	15	3	No
3	8	Severe gastritis (cisura angularis, antrum and pylorus) and duodenitis with ulcers (3)	Microspheres; No H. pylori bacilli	53	8	Argon plasma coagulation (after 13 mo of RE)1
4	7	Mucositis in gastric body; Extense ulcer in antrum (2)	Microspheres; No H. pylori bacilli	1	2	No
5	12	Deep ulcer in pyloric channel and severe mucositis in gastric antrum; Superficial ulcer in duodenal bulb (2)	Microspheres in lamina propia; No H. pylori bacilli	78	11	No
6	4	Severe mucositis in gastric antrum, with mucosal friability;Ulcer in pyloric cannel (2)	Microspheres in lamina propia; No H. pylori bacilli	1	2	No

¹A gastroenteroanastomosis was later performed (25 mo after the diagnosis of gastrointestinal ulcers). RE: Radioembolization; CTCAE: Common Terminology Criteria for Adverse Events.

Table 3 Clinical follow-up and treatment

Patient	Time from RE to symptoms (wk)	Clinical follow-up time (mo)	Symptoms (CTCAE v4.02 grading scale)			Treatment			Weight loss1 (kg)	Hemoglobin2 (g/dL)	Reason for end of endoscopic follow up
			Pain	Nausea and vomiting	Anorexia	Treatment used	Time on treatment (mo)	Clinical response
1	4	6	Epigastric pain (1)	No	No	Pantoprazole, domperidone and almagate	4	Yes	6	-1.5	Improvement
2	4	29	Epigastric pain (1)	Yes (1)	No	Esomeprazole, cinitapride sucralfate and ranitidine	8	Yes	7	-0.6	Improvement
3	4	88	Epigastric pain (2)	Yes (1)	Yes (3)	Pantoprazole, metoclopramide, sucralfate and cinitapride	10	Yes	17	-6.9	Improvement
4	2	9	Left subcostal pain (2)	Yes (1)	No	Pantoprazole, sucralfate and almagate	5	Yes	4	-3.1	Improvement
5	12	88	Epigastric pain (1)	Yes (1)	Yes (2)	Pantoprazole, pentoxifylline, esomeprazole and almagate	5	Yes	4	-1.6	Improvement; still on follow-up
6	4	3	Epigastric pain (2)	Yes (2)	Yes (2)	Esomeprazole, pentoxifylline and misoprostole	1	No	4.1	-2.4	Exitus

¹Maximal loss of weight over 4 mo;

²Maximal change in hemoglobin over 4 mo. CTCAE: Common Terminology Criteria for Adverse Events; RE: Radioembolization.