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Managing Y90 to the GI Tract with Dr. Oleksandra Kutsenko
In this brief interview, Oleksandra Kutsenko, MD at Red Rock Radiology Associates, shares how she successfully manages Y90 to the GI tract.
In this brief interview, Oleksandra Kutsenko, MD at Red Rock Radiology Associates, shares how she successfully manages Y90 to the GI tract.
Transcript
IO Learning:
Briefly describe to our readers how you manage Y90 to the GI tract.
Dr. Kutsenko:
Y90 radioembolization is an amazing technique that evolved as an adjunctive therapy for primary and metastatic disease in liver cancers. It has a lot of benefits and it prolongs survival and also improves quality of life of many patients and has multiple potential benefits in comparison to other techniques such as chemo or embolization of hepatic tumors. Unfortunately, as any therapy, it is not free of morbidity and mortality, with approximately 1% of cases having a 30 day all-cause mortality and 2.5% serious adverse events. Among some of those adverse events, there is also GI tract non-target embolization.
On average, people report up to 12% of occurrences of these adverse events. And in most of the cases, it is not clinically significant and may cause mild GI upset. However, in some cases, it may cause a serious problem in the GI tract such as stomach or duodenal ulcerations. Most of the ulcers develop in the antrum of the stomach or duodenum. And all are very relevant to intimate correlations of arteries that supply stomach and duodenum to arteries that supply liver.
As we do know, targeted Y90 embolization, the therapeutic embolization is possible because the majority of the tumors are supplied by hepatic arteries, in comparison to the majority of the liver, which is supplied by portal veins.
So, this difference in the ways in which the liver is supplied allows us to specifically target tumors with a decreased dose of these radioembolization particles to the liver. We impregnate microspheres with Yttrium 90, which is a beta emitter, and deliver these microspheres to the target tumor. Unfortunately, because there is a very intimate correlation between hepatic arteries and arteries to the GI tract, sometimes reflux of the particles or, also, if we do not see some branches that have common trunks, it may result in non-targeted embolization of the stomach or the duodenum with Y90. And it has been proven on biopsies that these embolizations actually occur, and they are very different from regular ulcers which mostly involve mucosa. Radiation-induced ulcers that mostly involve cirrhosis of the stomach are very difficult to treat. They're less susceptible to treatment with antireflux medications. They're less susceptible to removing NSAIDs, which we still recommend to do. But at the same time, a lot of these ulcers require surgical excision and prolonged therapy.
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