Analysis of the distribution of intra-arterial microspheres in human liver following hepatic yttrium-90 microsphere therapy

Campbell, Andrew B.; Bailey, Ian H; Burton, Mark

doi:10.1088/0031-9155/45/4/316

Cited by 148 publications

(111 citation statements)

References 13 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…Sections confirmed the presence of resin microspheres, which stained significantly darker than the gastric tissue and were easily visible. Deposition of microspheres in gastrointestinal tissue was inhomogeneous, with a cluster pattern similar to that of liver and tumor radioembolization, previously reported (16). Five of 6 animals demonstrated signs of minimally active, healing, or fully healed mucosal lesions, superficial to areas with higher submucosal microsphere density.…”

Section: Histopathologysupporting

confidence: 65%

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

et al. 2016

View full text Add to dashboard Cite

In 90 Y radioembolization, nontarget embolization to the stomach or small bowel can result in gastrointestinal injury, a rare but difficult to manage clinical complication. However, dosimetric thresholds for toxicity to these tissues from radioembolization have never been evaluated in a controlled setting. We performed an analysis of the effect of 90 Y radioembolization in a porcine model at different absorbed-dose endpoints. Methods: Six female pigs underwent transfemoral angiography and infusion of 90 Y-resin microspheres into arteries supplying part of the gastric wall. Esophagogastroduodenoscopy was performed after 4 wk to assess interim gastrointestinal health. Animals were monitored for side effects for 9 wk after 90 Y infusion, after which they were euthanized and their upper gastrointestinal tracts were excised for analysis. Histologic sections were used to map microsphere location, and a microdosimetric evaluation was performed to determine the absorbed-dose profile within the gastrointestinal wall. Results: 90 Y radioembolization dosages from 46.3 to 105.1 MBq were infused, resulting in average absorbed doses of between 35.5 and 91.9 Gy to the gastric wall. No animal exhibited any signs of pain or gastrointestinal distress through the duration of the study. Excised tissue showed 1-2 small (,3.0 cm 2 ) healed or healing superficial gastric lesions in 5 of 6 animals. Histologic analysis demonstrated that lesion location was superficial to areas of abnormally high microsphere deposition. An analysis of microsphere deposition patterns within the gastrointestinal wall indicated a high preference for submucosal deposition. Dosimetric evaluation at the luminal mucosa performed on the basis of microscopic microsphere distribution confirmed that 90 Y dosimetry techniques conventionally used in hepatic dosimetry provide a first-order estimate of absorbed dose. Conclusion: The upper gastrointestinal tract may be less sensitive to 90 Y radioembolization than previously thought. Lack of charged-particle equilibrium at the luminal mucosa may contribute to decreased toxicity of 90 One of the most severe side effects from 90 Y radioembolization in the treatment of liver cancer is gastrointestinal complication, including ulceration. Postradioembolization-induced gastrointestinal ulceration may occur after nontarget embolization (NTE) of radioactive microspheres into arteries supplying the esophagus, stomach, or duodenum, including the gastroduodenal artery, right-gastric artery, or other gastroenteric collaterals. Although the availability of published data is limited, incidence rates of gastrointestinal ulceration after hepatic 90 Y radioembolization are on the order of 3% (1).Despite the rarity of gastrointestinal ulceration, aggressive prophylaxis is directed toward preventing these complications, as coil occlusion of the gastroduodenal and right-gastric arteries are considered in pretreatment radioembolization planning. However, because coil occlusion often carries the consequence of formation of additional hepat...

show abstract

Section: Histopathologysupporting

confidence: 65%

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Liver biopsies obtained from colon cancer metastases previously treated with resin microspheres showed an incongruent deposition, with the majority being located near tumor nodules. Although similar numbers of spheres were found at the tumor center and normal liver, the periphery of the tumor contained a 200-times greater concentration of spheres, with microspheres typically grouped in clusters of a few to several dozen spheres per cluster (31,32). In analyses of HCC patients who received resin microspheres, dose calculations based on measurements performed during laparotomy yielded doses between 34 and 1,474 Gy for tumor tissue whereas normal liver parenchyma received 9-75 Gy, resulting in a ratio of the number of microspheres seen in the tumor periphery, compared with nonneoplastic liver tissue (T:N ratio), of 0.4:1 up to 45:1 (33).…”

Section: Discussionmentioning

confidence: 80%

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres

et al. 2013

View full text Add to dashboard Cite

90 Y radioembolization is a promising therapy for patients with primary and secondary liver malignancies. Pretherapeutic assessment consists of hepatic angiography and 99m Tc-macroaggregated albumin ( 99m Tc-MAA) perfusion scintigraphy to estimate the liver-to-lung shunt and exclude extrahepatic 99m Tc-MAA deposition. However, the predictive value of intratumoral 99m Tc-MAA uptake remains unclear. Methods: One hundred four patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer were treated with 90 Y radioembolization between December 2006 and December 2010. All of the patients underwent angiographic assessment and perfusion scintigraphy with 99m Tc-MAA before lobar 90 Y radioembolization. For inclusion, patients must have undergone pretherapeutic and follow-up MR imaging (6 wk and 3 mo after radioembolization, respectively). The degree of intratumoral 99m Tc-MAA uptake was rated, and liver metastases were classified according to changes in tumor diameter on both an individual and a patient basis using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Response at both time points, MAA uptake, and catheter position were then statistically analyzed in a linear and generalized linear mixed model at a significance level of 0.05 (P value). Results: Sixty-six patients with a total of 435 colorectal liver metastases (mean number of lesions 6 SD, 6.6 6 2.8; mean lesion size 6 SD, 33.8 6 21.2 mm; lesion size range, 10-154 mm) were included in this analysis. According to the patient-based analysis, 3 patients had partial response, 49 stable disease, and 6 progressive disease after 6 wk. After 3 mo, 5 patients showed partial response, 26 stable disease, and 17 progressive disease. There was no association of patient-based tumor response with overall 99m Tc-MAA uptake (P 5 0.172) or with catheter position (P 5 0.6456). Furthermore, an interaction effect of 99m Tc-MAA uptake and catheter position in relation to tumor response was not found (P 5 0.512). Moreover, in lesion-based analysis according to RECIST 1.1 there was no association of tumor response with degree of 99m Tc-MAA uptake, catheter position, or interaction of 99m Tc-MAA uptake and catheter position (P 5 0.339, 0.593, and 0.658, respectively). Conclusion: Response to 90 Y radioembolization was found to be independent of the degree of 99m Tc-MAA uptake. Therefore, therapy should not be withheld from patients with colorectal liver metastases lacking intratumoral 99m Tc-MAA accumulation. Radi oembolization with 90 Y is a promising catheterbased liver-directed modality approved by the Food and Drug Administration for the treatment of patients with hepatic metastases of colorectal carcinoma (1-4). For this interventional technique, 90 Y-embedded microspheres of glass or resin are infused directly into the hepatic arteries, where they become lodged within the tumor microvasculature and irradiate the tumor by b-emission (5).Perfusion scintigraphy with 99m Tc-labeled macroaggregated albumin ( 99m Tc-MAA) is mandatory before 90 Y radioem...

show abstract

“…(4,5). Knowledge of the patient-specific distribution of these microspheres may be critical to permit early prediction of treatment response.…”

Section: Fundingmentioning

confidence: 99%

SPIO-labeled Yttrium Microspheres for MR Imaging Quantification of Transcatheter Intrahepatic Delivery in a Rodent Model

Li¹,

Zhang²,

Gordon³

et al. 2016

Radiology

View full text Add to dashboard Cite

Analysis of the distribution of intra-arterial microspheres in human liver following hepatic yttrium-90 microsphere therapy

Cited by 148 publications

References 13 publications

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres

SPIO-labeled Yttrium Microspheres for MR Imaging Quantification of Transcatheter Intrahepatic Delivery in a Rodent Model

Contact Info

Product

Resources

About

Analysis of the distribution of intra-arterial microspheres in human liver following hepatic yttrium-90 microsphere therapy

Cited by 148 publications

References 13 publications

How Sensitive Is the Upper Gastrointestinal Tract to 90Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

How Sensitive Is the Upper Gastrointestinal Tract to 90Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

Predictive Value of Intratumoral 99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with 90Y-Microspheres

SPIO-labeled Yttrium Microspheres for MR Imaging Quantification of Transcatheter Intrahepatic Delivery in a Rodent Model

Contact Info

Product

Resources

About

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

How Sensitive Is the Upper Gastrointestinal Tract to ⁹⁰Y Radioembolization? A Histologic and Dosimetric Analysis in a Porcine Model

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres