Biliary Sequelae following Radioembolization with Yttrium-90 Microspheres

Purpose: Yttrium-90 (⁹⁰Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial ⁹⁰Y therapy in patients with HCC or liver metastases. Materials and Methods: All patients were treated with ⁹⁰Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. Results: A total of 327 patients (HCC, n = 190; liver metastases, n = 137) received 569 infusions of ⁹⁰Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n = 26; HCC, n = 7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n = 17), biloma (n = 3), cholecystitis (n = 2), gallbladder wall enhancement (n = 6), gallbladder wall rent (n = 3), abscess (n = 1), and stricture (n = 8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). Conclusions: ⁹⁰Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.