Gastric ulcer complicating a Selective Internal Radiation Therapy (SIRT) procedure for colorectal carcinoma metastasized to the liver

Colorectal cancer presents with metastatic disease in approximately 20% of newly diagnosed patients [1]. As surgery offers hope for a cure and only 25% of cases are resectable, regional therapy is an important option for the remaining patients. Selective Internal Radiation Therapy (SIRT) is a therapy that has been shown to provide significant local control in the liver and is generally well tolerated. Despite appropriate steps to limit the overall radiation to liver tumors, escaped particles may cause significant damage to local organs. In the case presented, SIRT was performed along with embolization of select stomach vasculature. A post-procedure radiation detection scan was negative. Unfortunately, the patient later developed radiation induced gastric ulceration where microscopic beads were demonstrated on gastric biopsy.