CardioVascular and Interventional Radiology

, Volume 36, Issue 5, pp 1320–1328 | Cite as

Safety of Repeated Yttrium-90 Radioembolization

  • Marnix G. E. H. Lam
  • John D. Louie
  • Andrei H. Iagaru
  • Michael L. Goris
  • Daniel Y. SzeEmail author
Clinical Investigation



Repeated radioembolization (RE) treatments carry theoretically higher risk of radiation-induced hepatic injury because of the liver’s cumulative memory of previous exposure. We performed a retrospective safety analysis on patients who underwent repeated RE.


From 2004 to 2011, a total of 247 patients were treated by RE. Eight patients (5 men, 3 women, age range 51–71 years) underwent repeated treatment of a targeted territory, all with resin microspheres (SIR-Spheres; Sirtex, Lane Cove, Australia). Adverse events were graded during a standardized follow-up. In addition, the correlation between the occurrence of RE-induced liver disease (REILD) and multiple variables was investigated in univariate and multivariate analyses in all 247 patients who received RE.


Two patients died shortly after the second treatment (at 84 and 107 days) with signs and symptoms of REILD. Both patients underwent whole liver treatment twice (cumulative doses 3.08 and 2.66 GBq). The other 6 patients demonstrated only minor toxicities after receiving cumulative doses ranging from 2.41 to 3.88 GBq. All patients experienced objective tumor responses. In the whole population, multifactorial analysis identified three risk factors associated with REILD: repeated RE (p = 0.036), baseline serum total bilirubin (p = 0.048), and baseline serum aspartate aminotransferase (p = 0.043). Repeated RE proved to be the only independent risk factor for REILD in multivariate analysis (odds ratio 9.6; p = 0.002). Additionally, the administered activity per target volume (in GBq/L) was found to be an independent risk factor for REILD, but only in whole liver treatments (p = 0.033).


The risk of REILD appears to be elevated for repeated RE. Objective tumor responses were observed, but establishment of safety limits will require improvement in dosimetric measurement and prediction.


Liver Radiation Radioembolization Repeated treatment Safety Toxicity 



We thank Jarrett Rosenberg for his support with the statistical analysis of the presented data.

Conflict of interest

Daniel Sze is on the medical or scientific advisory boards for Surefire Medical, Inc., Treus Medical, Inc., RadGuard Medical, Inc., Jennerex Biotherapeutics, Inc.; speaker’s bureau for W. L. Gore, Inc.; and is a consultant for Biocompatibles, Inc., and Sirtex, Inc. The other authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Marnix G. E. H. Lam
    • 1
    • 2
  • John D. Louie
    • 1
  • Andrei H. Iagaru
    • 3
  • Michael L. Goris
    • 3
  • Daniel Y. Sze
    • 1
    Email author
  1. 1.Division of Interventional RadiologyStanford University School of MedicineStanfordUSA
  2. 2.Department of Radiology and Nuclear MedicineUMC UtrechtUtrechtThe Netherlands
  3. 3.Division of Nuclear MedicineStanford University School of MedicineStanfordUSA

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