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CardioVascular and Interventional Radiology

, Volume 37, Issue 4, pp 1009–1017 | Cite as

Splenomegaly-Associated Thrombocytopenia After Hepatic Yttrium-90 Radioembolization

  • Marnix G. E. H. Lam
  • Arjun Banerjee
  • John D. Louie
  • Daniel Y. SzeEmail author
Clinical Investigation

Abstract

Purpose

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.

Results

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.

Conclusion

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.

Keywords

Thrombocytopenia Platelets Radioembolization Toxicity Spleen Liver 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

CRC

Colorectal cancer

ECOG

Eastern cooperative oncology group

EGFR

Epidermal growth factor receptor

HCC

Hepatocellular carcinoma

INR

International normalized ratio

MCV

Mean corpuscular volume

NCI-CTCAE

National cancer institute common toxicity criteria for adverse events

NE

Neuroendocrine tumours

RE

Radioembolization

RDW

Red blood cell distribution width

RFA

Radiofrequency ablation

SPECT

Single photon emission computed tomography

99mTcMAA

Technetium-99m-macroaggregated albumin

WBC

White blood cell

Notes

Acknowledgments

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.

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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
  • Arjun Banerjee
    • 1
  • John D. Louie
    • 1
  • Daniel Y. Sze
    • 1
    Email author
  1. 1.Division of Interventional RadiologyStanford University School of MedicineStanfordUSA
  2. 2.Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtNetherlands

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