Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort

Das, Arighno; Riaz, Ahsun; Gabr, Ahmed; Ali, Rehan; Mora, R.; Asadi, Ali Al; Mouli, S.; Lewandowski, Robert J.; Salem, Riad

doi:10.1007/s00259-019-04517-y

Cited by 14 publications

(16 citation statements)

References 18 publications

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“…A key concern in radioembolization therapy for advanced-staged HCC is the possible radiation-induced pneumonitis ensued by the hepatopulmonary shunting and deposition of 90Y microspheres in the lungs [15]. Based on data from external beam radiation therapy studies, the maximum lung absorbed dose of 30 Gy per radioembolization is advised for the prevention of radiationinduced lung injury [16].…”

Section: Discussionmentioning

confidence: 99%

Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

Yammine¹,

Khalifé²

2021

J Oncol Res Rev Rep

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Tumor thrombus infiltration of hepatocellular carcinoma (HCC) into the inferior vena cava and right atrium is rare and is associated with a poor prognosis due to the critical location of the tumor and the limited efficiency of the available treatment strategies. In this study, we report the case of a patient with advanced HCC and tumor thrombus in the inferior vena cava and right atrium who demonstrated complete response with mass retraction upon Yttrium-90 trans-arterial radioembolization (90Y- TARE) therapy. Throughout the 16 months follow-ups after the radioembolization, the patient was free of any complications, revealing no occurrence of radiation-induced pneumonitis or tumor recurrence.

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Section: Discussionmentioning

confidence: 99%

Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

Yammine¹,

Khalifé²

2021

J Oncol Res Rev Rep

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“…Additionally, Das and collegues have also recently reported a study of 103 patients who had LSF > 15% and no patient had features of Fig. 1 Comparison of the planar scintigraphic images of the case (1a, 1b) and reference patient for liver-lung shunt imaging and transaxial fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT-1e 1E) / computed tomography (CT-1c, 1d, 1f) images obtained after selective internal radiation therapy (SIRT) RP [15]. Dobrocky et al published a case report without related DLCO values where an asymptomatic patient had RP as confirmed both by imaging modalities and histopathologic evaluation [9].…”

Section: Discussionmentioning

confidence: 99%

Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report

et al. 2020

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Background: In the last years, Selective Internal Radiation Therapy (SIRT), using biocompatible Yttrium-90 (90Y) labeled microspheres have emerged for the treatment of malignant hepatic tumors. Unfortunately, a significant part of 90Ylabeled microspheres may shunt to the lungs after intraarterial injection. It can be predictable by infusing technetium-99 m-labeled macro-aggregated albumin particles through a catheter placed in the proper hepatic artery depending on the lobe to be treated with performing a quantitative lung scintigraphy. Radiation pneumonitis (RP) can occur 1 to 6 months after the therapy, which is a rare but severe complication of SIRT. Prompt timing of steroid treatment is important due to its high mortality rate. On the other hand, pulmonary diffusion capacity measured by carbon monoxide (DLCO) is an excellent way to measure the diffusing capacity because carbon monoxide is present in minimal amount in venous blood and binds to hemoglobin in the same manner as oxygen. Some authors reported that the most consistent changes after radiation therapy (RT) are recorded with this quantitative reproducible test. The relationship between the proportional reductions in DLCO and the severity of RP developing after this therapy may prove to be clinically significant. Case presentation: We herein present a patient who developed RP after SIRT that could be quantified using DLCO. To the best of our knowledge, this case is the first who developed unexpected RP after SIRT with significant decrease in DLCO with internal radiation exposure. Conclusions: RP is a very rare complication and may lead to a fatal outcome. Decline in DLCO could be a valuable parameter for follow-up and to identify potential candidates for RP and could be also another trigger for administration of steroid therapy with prompt timing in this patient group.

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“…The median lung dose per session and cumulative lung dose were 22.9 and 29.5 Gy. Twenty patients (19%) developed non-specific pulmonary complaints in the first year, none attributable to 90 Y-TARE, and no RILI was observed [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

Girardet

Boughdad

Digklia

et al. 2020

Cardiovasc Intervent Radiol

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Hepatocellular carcinoma (HCC) has the tendency to invade the portal and/or hepatic venous system. The invasion of the right atrium is uncommonly observed and constitutes a treatment challenge. We report the case of a patient with HCC invading the right atrium treated with 90Yttrium-transarterial radioembolization (90Y-TARE). Following the treatment, organizing pneumonia secondary to nivolumab occurred, raising the question of an interaction between 90Y-TARE and nivolumab.

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Safety and efficacy of radioembolization with glass microspheres in hepatocellular carcinoma patients with elevated lung shunt fraction: analysis of a 103-patient cohort

Cited by 14 publications

References 18 publications

Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

Unexpected radiation pneumonitis after SIRT with significant decrease in DLCO with internal radiation exposure: a case report

Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

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