Incidence of Gastrointestinal Adverse Events Following Left Hepatic Lobe Radiation Segmentectomy for the Treatment of Hepatocellular Carcinoma.

purposeDescribe the incidence and severity of gastrointestinal tract-related adverse events (GIAE) following radiation segmentectomy (RS) for hepatocellular carcinoma (HCC) in the left hepatic lobe. MATERIALS AND

methodsA single-center retrospective analysis of patients with solitary, treatment-naïve, HCC in the left hepatic lobe who underwent Yttrium-90-containing glass microsphere RS from 6/2017-9/2023 was performed. Clinical, endoscopic apparent, and surgical GIAE up to last available follow-up were graded per the Common Terminology Criteria for Adverse Events. Tumor-to-GI tract distance and treatment parameters were evaluated for associations with GIAE.

resultsForty-six patients with a median tumor size of 2.4 cm (IQR 2.1, 3.6) and median follow-up of 931 days (IQR 527, 1412) met inclusion criteria. Median treatment dose was 533 Gy (IQR 456, 853). Grade 1 GIAE were documented on 14 (30%) patients, including nausea/emesis (n = 12) and gastritis/duodenitis (n = 2). Grade 2 GIAE were documented in 2 (4%) patients with either multifocal gastric and duodenal ulcers or gastric erosions per endoscopy performed at a median of 53 days post-RS without histologic evidence of Yttrium-90 microspheres or radiation injury. In the 18 patients who underwent subsequent liver transplantation or hepatectomy, increased surgical dissection time was documented in 6 (33%) patients secondary to presumed radiation-related adhesions. Two surgical cases (11%) had grade 4 AE, which included intraoperative hemorrhage and duodenal avulsion. No significant association was found between GIAE and tumor-to-GI tract distance, dosimetry, or treatment parameters.

conclusionThe incidence of severe GIAE following RS for HCC in the left hepatic lobe was low. Surgical adhesions after RS were common, but most did not increase surgical morbidity.