Y-90 Liver Toxicity: Understanding and Preventing REILD

Y-90 Liver Toxicity: Understanding and Preventing REILD

This episode investigates the specific, aggressive liver injury that can follow Y-90 Radioembolization—Radioembolization-Induced Liver Disease (REILD)—defining it not as simple radiation necrosis, but as Hepatic Sinusoidal Obstruction Syndrome (SOS), essentially Veno-Occlusive Disease (VOD).

• The Clinical Picture: We identify the hallmark presentation appearing 4-8 weeks post-procedure: significant jaundice (Bilirubin >3) and ascites in the absence of tumor progression.

• The "Combined Insult" Theory: The discussion highlights that this injury is often synergistic, occurring when the liver is "primed" by prior systemic chemotherapy, making the tissue far more vulnerable to radiation.

• The Safety Limit: We detail the critical safety threshold found in the literature: keeping the dose below 0.8 GBq per liter of targeted liver volume significantly drops the risk.

• Protocol for Prevention: The episode outlines a proven modified protocol—including strict patient selection (Bilirubin <2), ursodiol/steroid prophylaxis, and a 2-month chemotherapy-free interval—that reduced the rate of severe toxicity from 13.3% down to 2.2%.

• Rescue Therapy: We explore why TIPS is often considered for acute management to decompress the portal hypertension caused by the sinusoidal obstruction.

Tune in to learn the dosimetry limits and patient selection criteria that keep your Y-90 practice safe.