Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

Spreafico, Carlo; Morosi, Carlo; Maccauro, Marco; Romito, Raffaele; Lanocita, Rodolfo; Civelli, Enrico; Sposito, Carlo; Bhoori, Sherrie; Chiesa, Carlo; Frigerio, Laura; Lorenzoni, Alice; Cascella, Tommaso; Marchianò, Alfonso; Mazzaferro, Vincenzo

doi:10.1007/s00270-014-0921-2

Cited by 23 publications

(17 citation statements)

References 25 publications

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“…Furthermore, it was shown that redistribution of hepatic blood flow by means of embolizing certain hepatic arteries is not always successful. This method is commonly applied in RE and other interventions such as trans-arterial chemoembolization, to simplify procedures and to reduce risk of complications [8,9]. Case #4 was one of several cases in which this redistribution was not evident on posttreatment imaging.…”

Section: Discussionmentioning

confidence: 99%

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

Alsultan

Smits

Barentsz

et al. 2019

Clin Transl Imaging

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Introduction Distribution of microspheres after radioembolization can be accurately visualized using PET/CT. In this pictorial essay, we aim to demonstrate the value of 90 Y-PET/CT after radioembolization. Methods 90 Y-PET/CT imaging was routinely performed after radioembolization at our institute. Patients were scanned the same day or the day after treatment, using a scanner with time-of-flight technology. We retrospectively reviewed all 90 Y-PET/ CTs from patients treated with radioembolization (both glass and resin microspheres) between January 2011 and January 2019. Five cases were selected that are illustrative of the added value of PET/CT after radioembolization. Results 90 Y-PET/CT allows for distribution assessment and dosimetry of 90 Y-microspheres. It was used for the assessment of treatment success by visualization of tumor targeting, quantification of the absorbed dose, prediction of complications such as radioembolization-induced liver disease, and determining the required dosage for retreatment. Conclusion PET/CT is an excellent modality for post-treatment imaging of 90 Y-microspheres and could lead to improved dose planning and more personalized treatment.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 99%

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

Alsultan

Smits

Barentsz

et al. 2019

Clin Transl Imaging

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“…An innovative approach to dealing with coil migration into the vascular distribution of prospective 90 Y RE is intrahepatic vascular flow redistribution, a strategy used to consolidate arterial flow to tumors by embolizing accessory feeders to allow single vessel 90 Y RE. 13,14 In this scenario, complete occlusion of the branch vessel into which coil migration occurred may be used to develop collateral blood supply from other intrahepatic arteries to allow 90 Y administration (►Fig. 14); while not an ideal circumstance, this approach may be the most successful in some patients.…”

Section: Embolization Techniquementioning

confidence: 99%

Planning Arteriography for Yttrium-90 Microsphere Radioembolization

Gaba

2015

Semin intervent Radiol

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).Yttrium-90 radioembolization ( 90 Y RE) is a contemporary transcatheter locoregional therapy for primary and secondary hepatic malignancies that is commonly utilized in modern Interventional Radiology (IR) practice. 1 Unlike other targeted endovascular therapies, such as transarterial chemoembolization (TACE) and transarterial embolization (TAE), the current standard of care protocol for 90 Y RE treatment of liver tumors involves a two-stage treatment process consisting of a planning arteriography procedure followed by the therapeutic 90 Y RE, typically performed 1 to 2 weeks later. The diagnostic planning procedure has threefold intent: (1) to delineate hepatic and tumor vascular anatomy relevant to 90 Y microsphere dosimetry and administration; (2) to identify and possibly embolize extrahepatic vessels at risk for nontarget microsphere deposition; and (3) to quantify the degree of hepatopulmonary shunting using technetium-99m macroaggregated albumin ( 99m Tc-MAA) scanning. 2 Given the multifactorial basis for performance of mapping arteriography, and despite some literature guidelines outlining procedure methodology, 3,4 this procedure is often technically challenging, labor intensive, and time consuming. This article aims to present a simple overview of a single operator's technical approach to planning arteriography performed prior to 90 Y RE-including tips, tricks, and pitfalls-based on experience gained in having performed hundreds of hepatic arteriography procedures. Technical details of 90 Y RE dosimetry and microsphere administration are beyond the scope of the current topic, and will not be discussed. Preprocedure ConsiderationsAs with all IR locoregional liver therapies, 90 Y RE treatment at the author's institution is preceded by an IR clinic consultation. The intent of the outpatient encounter is to obtain patient historical information; to perform a baseline physical examination; to identify any potential procedural contraindications; and to review the patient's diagnosis and treatment plan, as well as clinical outcome goals and expectations with him/her. Relevant contraindications to 90 Y RE are well described, 5 but particular attention is paid to baseline performance status and serum bilirubin level, which, if elevated, may preclude treatment. While renal insufficiency does not represent an absolute procedural contraindication, the author prefers to pursue a single-session therapy such as transarterial chemoembolization as opposed to two-stage 90 Y RE to limit iodinated contrast volume administered to patients with kidney dysfunction. In terms of other preprocedure needs, all patients should have an up-to-date, highquality contrast-enhanced triple-phase (liver protocol) computed tomography (CT) or magnetic resonance (MR) imaging scan for baseline tumor staging, ideally performed within a couple of weeks of initial therapy. On the day of the arteriography procedure, prophylactic antibiotics are typically not required. General Procedure ApproachThe ternary objective of the planning arteriogram p...

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“…Dosimetry information is summarized in Table 2. Required 90 Y glass microsphere activity (TheraSphere ® ; BTG International, West Conshohocken, PA) was determined based on the target liver absorbed dose of 90-120 Gy, the volume of the liver tissue to be treated, and LSF using standard methodology (26). For the purpose of dose calculations, residual activity in the treatment vial was assumed to be 1%.…”

Section: Dosimetry and Treatmentmentioning

confidence: 99%

“…Vessels targeted for protective embolization and lung shunt study results are summarized in Table 2. Hepatic arterial flow consolidation (25,26) was attempted in three patients by embolizing accessory right or left hepatic artery branches. Lung shunt fraction (LSF) was calculated on the basis of planar images using standard methodology (26).…”

Section: Patient Evaluationmentioning

confidence: 99%

“…Hepatic arterial flow consolidation (25,26) was attempted in three patients by embolizing accessory right or left hepatic artery branches. Lung shunt fraction (LSF) was calculated on the basis of planar images using standard methodology (26). Oral prophylactic therapy using a proton pump inhibitor (PPI) (typically omeprazole) was initiated seven days prior to first planned 90 Y administration (27).…”

Section: Patient Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

Fidelman

Kerlan

Taylor

et al. 2015

Journal of Vascular and Interventional Radiology

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Background: This prospective pilot single-institution study was undertaken to document the feasibility, Majority of clinical AE were grade 1 or 2 in severity. Patients with colorectal cancer had hepatic objective response rate (ORR) of 25% and a hepatic disease control rate (DCR) of 80%. Median PFS and OS were 1.0 and 4.4 months, respectively. Patients with neuroendocrine tumors (NET) had hepatic ORR and DCR of 73% and 100%, respectively. Median PFS was 8.9 months for this cohort. DCR and median PFS and OS for patients with cholangiocarcinoma were 86%, 1.1 months, and 6.7 months, respectively. Conclusions: 90 Y glass microspheres device has a favorable safety profile, and achieved prolonged disease control of hepatic tumor burden in a subset of patients, including all patients enrolled in the neuroendocrine cohort.

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Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

Cited by 23 publications

References 25 publications

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

Planning Arteriography for Yttrium-90 Microsphere Radioembolization

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

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