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



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.


Thrombocytopenia Platelets Radioembolization Toxicity Spleen Liver 



Alanine aminotransferase


Aspartate aminotransferase


Colorectal cancer


Eastern cooperative oncology group


Epidermal growth factor receptor


Hepatocellular carcinoma


International normalized ratio


Mean corpuscular volume


National cancer institute common toxicity criteria for adverse events


Neuroendocrine tumours




Red blood cell distribution width


Radiofrequency ablation


Single photon emission computed tomography


Technetium-99m-macroaggregated albumin


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.


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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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