RADIATION PNEUMONITIS FOLLOWING Y90 RADIOEMBOLIZATION DESPITE LOW SHUNT FRACTION AND TOTAL LUNG RADIATION EXPOSURE

TOPIC: Imaging TYPE: Fellow Case Reports INTRODUCTION: Radiation pneumonitis is a rare complication following Y90 radioembolization therapy of inoperable hepatic neoplasms. The incidence estimated to be about 1% provided therapeutic regimens adhere the current guidelines for radiation dose and calculated shunt fraction. Literature shows that glass microspheres are less likely cause as compared resin microspheres. Here, we present case after with microspheres, low fraction, total lung exposure within acceptable levels. CASE PRESENTATION: A 54 year old woman past medical history alcohol- induced cirrhosis complicated by hepatocellular carcinoma presented an abnormal CT chest. She denied having prior pulmonary disease. endorsed occasional cough but shortness breath, sputum production, hemoptysis, fevers or chills. was smoker (8 pack years) who quit 4 years ago. There were no other significant exposures. Two before this presentation, she received (x2) carcinoma. Her work-up receiving revealed 11.7%. during procedures 21. 3 Gy 6.4 respectively. cumulative 27.7 remained below 30 per embolization, 50 dose. Despite this, imaging showed multifocal sharply defined peri-bronchovascular reticular focal consolidative opacites architectural distortion bronchiectasis most prominently in bilateral upper lobes, which radiologically consistent pneumonitis. DISCUSSION: Current limits regarding embolization based on small study patients developed clinical embolization. These use standard radiation. Data suggest higher levels can tolerated parenchyma without development pneumonitis; however, our questions currently accepted safe limit lungs. CONCLUSIONS: maybe benefit measures monitor ensure timely treatment if detected prevent pentoxifylline due concerns lower doses may result effective REFERENCE #1: • Nag, Subir, et al. "Recommendations Radioembolization Hepatic Malignancies Using Yttrium-90 Microsphere Brachytherapy: Consensus Panel Report from Brachytherapy Oncology Consortium (REBOC)." Brachytherapy, vol. 6, no. 2, 2007, pp. 116–117. #2: Leung, Thomas W.T., "Radiation Pneumonitis Selective Internal Treatment Intraarterial 90Yttrium-Microspheres Inoperable Tumors." International Journal Oncology*Biology*Physics, 33, 4, 1995, 919–924., doi:10.1016/0360-3016(95)00039-3. #3: Salem, Riad, "Incidence After Intra-Arterial Radiotherapy With Microspheres Assuming Uniform Lung Distribution." American Clinical Oncology, 31, 5, 2008, 431–438., doi:10.1097/coc.0b013e318168ef65. DISCLOSURES: No relevant relationships Megan Konopka, source=Web Response