Dose Delivery Estimated by Bremsstrahlung Imaging and Partition Model Correlated with Response Following Intra-arterial Radioembolization with 32P-Glass Microspheres for the Treatment of Hepatocellular Carcinoma

Wang, Xiaodong; Yang, Renjie; Xi-cai, Cao; Tan, Jian; Li, Bin

doi:10.1007/s11605-010-1180-4

Cited by 10 publications

(9 citation statements)

References 21 publications

(31 reference statements)

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“…Using an intra-arterial AT-II infusion during RE may prove a way to overcome the problem of unfavorable T/N ratios, and optimize treatment-efficacy. Various studies have found an association between tumor absorbed radiation doses, tumor response and overall survival [39], [40], [41], [42]. It can, therefore, be expected that improved tumor selectivity of radioactive microsphere distribution will positively affect patient outcome after RE.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intra-Arterial Angiotensin II on the Hepatic Tumor to Non-Tumor Blood Flow Ratio for Radioembolization: A Systematic Review

et al. 2014

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PurposeTreatment efficacy of intra-arterial radioembolization for liver tumors depends on the selective targeting of tumorous tissue. Recent investigations have demonstrated that tumors may receive inadequate doses of radioactivity after radioembolization, due to unfavorable tumor to non-tumor (T/N) uptake ratios of radioactive microspheres. Hepatic arterial infusion of the vasoconstrictor angiotensin II (AT-II) is reported to increase the T/N blood flow ratio. The purpose of this systematic review was to provide a comprehensive overview of the effect of hepatic arterial AT-II on T/N blood flow ratio in patients with hepatic malignancies, and determine its clinical value for radioembolization.MethodsThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A structured search was performed in the PubMed, EMBASE and Cochrane databases. Only studies that presented data on T/N ratios before and after infusion of AT-II into the hepatic artery, in human patients with hepatic malignancies, were selected. Median T/N ratios before, during and after AT-II infusion, and the median T/N ratio improvement factor were extracted from the selected articles. All data on systemic blood pressure measurements and clinical symptoms were also extracted.ResultsThe search identified 524 titles of which 5 studies, including a total of 71 patients were considered relevant. Median T/N ratios before infusion of AT-II ranged from 0.4 to 3.4. All studies observed a substantial improvement of the T/N ratio after AT-II infusion, with median improvement factors ranging from 1.8 to 3.1. A transitory increase of systemic blood pressure was observed during AT-II infusion.ConclusionsInfusion of AT-II into the hepatic artery leads to an increase of the tumor to non-tumor blood flow ratio, as measured by T/N uptake ratios. Clinical trials are warranted to assess safety aspects, optimal administration strategy and impact on treatment efficacy during radioembolization.

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Section: Discussionmentioning

confidence: 99%

The Effect of Intra-Arterial Angiotensin II on the Hepatic Tumor to Non-Tumor Blood Flow Ratio for Radioembolization: A Systematic Review

et al. 2014

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“…Despite these problems, BS imaging is important in confirming the satisfactory delivery, pharmacokinetics, and potential abnormal deposition of the radiotracer [16, 25–29]. Furthermore, it has been demonstrated that BS imaging is useful for the direct quantification and dosimetry of β -emitter isotopes in clinical practice [4, 30–32]. We evaluated optimized parameters for 32 P BS imaging after the RE of the hepatic tumors, and to our knowledge, this is the first clinical study to assess these factors to improve image quality.…”

Section: Discussionmentioning

confidence: 99%

Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters

Pirayesh

Amoui

Akhlaghpoor

et al. 2014

Radiology Research and Practice

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Background. Bremsstrahlung (BS) imaging during radioembolization (RE) confirms the deposition of radiotracer in hepatic/extrahepatic tumors. The aim of this study is to demonstrate 32P images and to optimize the imaging parameters. Materials and Methods. Thirty-nine patients with variable types of hepatic tumors, treated with the intra-arterial injection of 32P, were included. All patients underwent BS SPECT imaging 24–72 h after tracer administration, using low energy high resolution (LEHR) (18 patients) or medium energy general purpose (MEGP) (21 patients) collimators. A grading scale from 1 to 4 was used to express the compatibility of the 32P images with those obtained from CT/MRI. Results. Although the image quality obtained with the MEGP collimator was visually and quantitatively better than with the LEHR (76% concordance score versus 71%, resp.), there was no statistically significant difference between them. Conclusion. The MEGP collimator is the first choice for BS SPECT imaging. However, if the collimator change is time consuming (as in a busy center) or an MEGP collimator is not available, the LEHR collimator could be practical with acceptable images, especially in a SPECT study. In addition, BS imaging is a useful method to confirm the proper distribution of radiotherapeutic agents and has good correlation with anatomical findings.

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“…Various studies have found an association between tumor absorbed radiation doses, tumor response and overall survival. [39,40,41,42] It can, therefore, be expected that improved tumor selectivity of radioactive microsphere distribution will positively affect patient outcome after RE.…”

Section: Author (Year)mentioning

confidence: 99%

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

Hoven

Smits

Rosenbaum

et al. 2014

Journal of Vascular and Interventional Radiology

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Purpose: Treatment efficacy of intra-arterial radioembolization for liver tumors depends on the selective targeting of tumorous tissue. Recent investigations have demonstrated that tumors may receive inadequate doses of radioactivity after radioembolization, due to unfavorable tumor to non-tumor (T/N) uptake ratios of radioactive microspheres. Hepatic arterial infusion of the vasoconstrictor angiotensin II (AT-II) is reported to increase the T/N blood flow ratio. The purpose of this systematic review was to provide a comprehensive overview of the effect of hepatic arterial AT-II on T/N blood flow ratio in patients with hepatic malignancies, and determine its clinical value for radioembolization.Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A structured search was performed in the PubMed, EMBASE and Cochrane databases. Only studies that presented data on T/N ratios before and after infusion of AT-II into the hepatic artery, in human patients with hepatic malignancies, were selected. Median T/N ratios before, during and after AT-II infusion, and the median T/N ratio improvement factor were extracted from the selected articles. All data on systemic blood pressure measurements and clinical symptoms were also extracted. Results:The search identified 524 titles of which 5 studies, including a total of 71 patients were considered relevant. Median T/N ratios before infusion of AT-II ranged from 0.4 to 3.4. All studies observed a substantial improvement of the T/N ratio after AT-II infusion, with median improvement factors ranging from 1.8 to 3.1. A transitory increase of systemic blood pressure was observed during AT-II infusion.Conclusions: Infusion of AT-II into the hepatic artery leads to an increase of the tumor to non-tumor blood flow ratio, as measured by T/N uptake ratios. Clinical trials are warranted to assess safety aspects, optimal administration strategy and impact on treatment efficacy during radioembolization.

show abstract

Dose Delivery Estimated by Bremsstrahlung Imaging and Partition Model Correlated with Response Following Intra-arterial Radioembolization with 32P-Glass Microspheres for the Treatment of Hepatocellular Carcinoma

Cited by 10 publications

References 21 publications

The Effect of Intra-Arterial Angiotensin II on the Hepatic Tumor to Non-Tumor Blood Flow Ratio for Radioembolization: A Systematic Review

The Effect of Intra-Arterial Angiotensin II on the Hepatic Tumor to Non-Tumor Blood Flow Ratio for Radioembolization: A Systematic Review

Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters

The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review

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