SIR 2024
Interventional Oncology
Jason C. Smith, MD
Faculty
Loma Linda University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
TARE has matured over the last couple decades and has recently been incorporated into the BCLC guidelines for the management of HCC. It has morphed from a primarily palliative lobar therapy to an increasingly more targeted and therapeutic treatment. There has been concomitant sophistication in dosimetry and escalation of dosing, with increased dose to both tumor and adjacent structures. While the safety of conventional dosing TARE has been well established, it remains unclear what constitutes the safe upper limits of increasingly higher doses (1).
Clinical Findings/Procedure Details:
Post TARE systemic constitutional symptoms (e.g. post embolization syndrome (fatigue, pain, low grade fever) are common, but usually fairly easily manageable. More localized injuries to both targeted and non-targeted tissues are less common and may usually be avoided by meticulous approach to angiography and dosimetry. This abstract will focus on some of the lesser known complications that have been reported and/or experienced in recent years and may have arisen from higher, ablative dosing (think a drop of habanero sauce in a teaspoon of chile versus in a pot of chili). Examples include biliary-caval fistula, bilo-enteric fistula, colitis, both gastric and colonic ulceration, gastric outlet obstruction, IVC stricture/occlusion, cholecystitis, and ruptured HCC. Case examples will be shown.
Conclusion and/or Teaching Points: Radiation segmentectomy, while increasingly being utilized and supported for the successful treatment of various liver malignancies carries unique risks of complications compared to conventional lobar dosing. In this poster, we present an overview of potential adverse events from Y-90 TARE with a focus on less commonly encountered, but recently reported outcomes some of which may be related to higher than conventional ablative doses and related to adjacency of perfused tissue to non-target anatomy. Therefore, it is prudent for interventionalists to consider these less well documented side effects when planning and consenting for ablative TARE procedures.