Radioembolization with yttrium-90 microspheres work up: Practical approach and literature review

Abstract

Radioembolization (RE) is a selective internal radiotherapy technique in which yttrium-90 blended microspheres are infused through the hepatic arteries. It is based on the fact that primary and secondary hepatic tumors are vascularized mostly by arterial blood flow whereas healthy hepatocytes obtain their blood supply mostly from the portal network. This enables high radiation doses to be delivered, sparing the surrounding non-malignant liver parenchyma. Most of the complications are caused by unexpected particles passing into the gastrointestinal tract through branches originating from the main hepatic arterial supply. Knowledge of this hepatic arterial network and of its variations and the technical considerations this raises are required in preparation for treatment. This work describes the specific anatomical features and techniques for this anatomy through recent literature illustrated by cases from our own experience.

Deep Ultraviolet Emitting Scintillators for Biomedical Applications: The Hard Way of Downsizing LuPO4:Pr3+

“…Moreover, in comparison to conventional brachytherapy concepts, in which radioactive radiation sources such as yttrium‐90 (τ 1/2 = 64.1 h) are used, the scintillator nanoparticles are not consumed by the downconversion and can be excited multiple times in fractionated radiation therapies with the same effect during the whole treatment period …”

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

“…At present, most experienced centers try to avoid coil embolization. Significant extrahepatic depositions are found mostly within the distribution of 3 distinct side-branches (Table 3): the gastroduodenal artery, cystic artery, and right gastric artery (20,21). In a recent case series of 134 patients, 68.7% did not undergo coil embolization of either the gastroduodenal artery or right gastric artery.…”

“…Anatomic variants of the hepatic arterial vasculature are common, and correct identification of these variants is essential as it may increase the risk of extrahepatic deposition (20). Information on arterial liver vascularization derived from preprocedural liver CT-angiography or MR imagingangiography (e.g., with an early arterial phase) is paramount for successful angiography (19,21). Anatomic variants are frequently missed in clinical practice in the absence of a thorough evaluation of the arterial vascularization on multimodality imaging.…”

Vascular Redistribution for SIRT—A Quantitative Assessment of Treatment Success and Long-Term Analysis of Recurrence and Survival Outcomes

“…Transcatheter hepatic arterial radioembolization with Yttrium 90 ( 90 Y) microspheres is an established, effective treatment modality for patients with unresectable primary and metastatic liver-dominant malignancy and a life expectancy of above 3 months. [1][2][3][4][5][6][7] Liver tumors above 3 mm have a predominantly arterial vascularization so that intra-arterial administration of microparticles containing 90 Y become trapped in the arterioles and capillaries of the tumor. 8,9 90 Y is a pure beta emitter that has a radiotherapeutic effect on an area of approximately 1 cm surrounding the site where it is deposited.…”

“…There is consensus in the literature that the gastroduodenal artery (GDA) and the right gastric artery (RGA) should be prophylactically embolized. [1][2][3]7 Some authors also recommend cystic artery embolization to minimize exposure of the gallbladder to radioactive particles; however, this is not the practice at our institution. 12 In our experience, partial or complete coil embolization of the LHA, or of accessory hepatic arteries, is sometimes required to prevent extrahepatic deposition of 90 Y microspheres or to facilitate treatment by limiting the number of treatment catheter positions required.…”