RADIOEMBOLIZATION INDUCED CHRONIC HEPATOTOXICITY, A SYSTEMATIC LITERATURE REVIEW

Abstract

Trans-arterial radioembolization (TARE) is a treatment used in liver cancers and other types of cancers that spread to the liver, when surgery is not possible. It works by delivering high doses of radiation in the tumour through the blood vessels that feed the tumour. The treatment is effective and extends the lifetime of patients. Nevertheless, some practitioners have observed that this technique can affect healthy parts of the liver as well causing long term toxicity in the liver which affects the function of this organ if the patient survives the cancer. This review looked at studies that followed patients for over 6 months of time, when the long-term effects of the radioembolization are expected to appear in most patients. The goal was to understand more about how this long-term effect clinically manifests, how it is characterized, assessed and managed. We also aimed at compiling a definition for this Radioembolization Induced Liver disease (now referred to as RECHT). The review includes articles from 2 databases: Embase and Pubmed. We found a total of 217 articles, but only 8 were included in this review. Most of the articles were retrospective studies, there was a single case report and a prospective registry study. These articles have an important limitation, not all interesting aspects about RECHT were reported and therefore it was difficult to make conclusions regarding many aspects, like incidence and the real time to onset or any relationship with the calculation of the radioembolization dose calculation and the risk of TARE. Yet, the literature highlights some characteristics that can be of help for practitioners to identify new RECHT cases. For example, the time for the symptoms to appear may start at 6 months but it can be long after the treatment, therefore blood tests on liver function for a long follow up period are important. Morphological changes in the liver are also a common marker for RECHT, patients should also be monitored on this regard. The overall message of this review is that TARE remains an important and safe treatment for patients with liver tumours when surgery is not a possibility. However, the risk of RECHT is real and should be addressed with careful long-term monitoring and clear communication with patients about this risk. Literature found allowed for the formulation of a broad definition of RECHT, which can serve as a practical guide for doctors to detect and report on RECHT.