Splenomegaly-Associated Thrombocytopenia After Hepatic Yttrium-90 Radioembolization
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Thrombocytopenia is often observed after yttrium-90 radioembolization (RE). Possible mechanisms include radiation toxicity to the bone marrow, consumption in the liver due to local radiation effects, and sequestration in the spleen. We sought to identify the causative factors.
Materials and Methods
Patients with complete baseline and 3-month post-RE imaging and laboratory data were included in this retrospective analysis. Univariate and multivariate regression analyses were performed on clinical, procedural, and imaging data.
A total of 116 patients were identified (65 male, 51 female; median age 64 years). Forty-six patients were treated for primary and 70 for metastatic liver malignancy. Of these, 86 were treated with resin and 30 with glass microspheres; median activity was 1.85 GBq. Eighty-three patients underwent whole-liver treatment. Maximum individual change in platelet count was −20.2 % leading to new or increased grade of thrombocytopenia in 48 patients (41.4 %) by National Cancer Institute Common Toxicity Criteria for Adverse Events version 4.02 criteria. Independent risk factors for decreased platelet count included change in spleen volume (median change +17.5 %; p = 0.001) and whole-liver (rather than lobar or segmental) treatment (p = 0.025). Administered activity and absorbed dose were not associated with change in platelet count. The change in spleen volume itself was associated with previous epidermal growth factor receptor–inhibitor treatment (p = 0.002), whole-liver absorbed dose (p = 0.027), and multiple-line chemotherapy (0.012) for whole-liver treatments only.
Post-RE treatment increase of spleen volume is correlated with decreased peripheral platelet count suggesting a mechanism of increased portal hypertension and hypersplenism being responsible.
KeywordsThrombocytopenia Platelets Radioembolization Toxicity Spleen Liver
Eastern cooperative oncology group
Epidermal growth factor receptor
International normalized ratio
Mean corpuscular volume
National cancer institute common toxicity criteria for adverse events
Red blood cell distribution width
Single photon emission computed tomography
White blood cell
We thank Marc Sofilos for support with three-dimensional volumetry.
Conflict of interest
Daniel Sze is on the medical or scientific advisory boards for Surefire Medical, Inc., Treus Medical, Inc., RadGuard Medical, Inc., and Jennerex Biotherapeutics, Inc. He is also on the speaker’s bureau for W. L. Gore, Inc., and has provided clinical trial consultation for Sirtex, Inc., Nordion, Inc., and Biocompatibles, Inc. All other authors have nothing to disclose.
- 27.Fernandez-Ros N, Silva N, Bilbao JI, et al. (2013) Partial liver volume radioembolization induces hypertrophy in the spared hemiliver and no major signs of portal hypertension. HPB (Oxford). doi: 10.1111/hpb.12095