Safety of radioembolization in the setting of angiographically apparent arterioportal shunting

Abstract

transarterial chemoembolization (cTACE) vs. yttrium-90 radioembolization (Y90) for Hepatocellular Carcinoma (HCC). Materials: With IRB approval, 45 patients with unresectable HCC were prospectively randomized to cTACE vs. Y90 [PREMIERE TRIAL (1)]. From this cohort, the fluoroscopy times and doses were recorded for all of these patients' procedures. Statistical comparison between both cohorts was conducted using independent sample t-test assuming unequal variances. Statistical significance was set at po0.05. Results: Twenty-one patients received cTACE (32 treatment sessions) and 24 patients received Y90 (29 treatment sessions) with glass microspheres. All Y90 patients had a separate planning angiogram prior to radioembolization. Mean fluoroscopic time (95%CI) for the planning angiography prior to Y90 was 11.6 minutes (9.3-14) and mean fluoroscopic dose was 1611 mGy (969-2253). Mean fluoroscopy time (95%CI) for Y90 treatment procedures was 13.3 minutes (10-16.5) and 18.3 minutes (15.5-21) for cTACE procedures (P ¼ 0.021). Mean fluoroscopic dose (95%CI) for Y90 treatment was 1154 mGy (712-1596) and 1834 mGy (1356-2312) for cTACE (P ¼ 0.035). Mean accumulative fluoroscopic time/dose for Y90 included the dose administered on planning angiography and on treatment day. Mean accumulative fluoroscopy time (95%CI) for cTACE patients after multiple treatments was 29 minutes (21-38) and 28 minutes for Y90 patients (24-33) (P ¼ 0.8213). Mean fluoroscopic dose (95%CI) for Y90 patients was 2978 mGy and 3941 mGy (1830-6053) for cTACE patients (P ¼ 0.4). Conclusions: Y90 radioembolization exposes patients to significantly less fluoroscopy time and dose compared to cTACE per treatment session. When combined with planning angiography, there is no statistically significant difference in fluoroscopy time and dose between Y90 and cTACE.

Radioembolization for hepatocellular carcinoma: what clinicians need to know

“…paTIeNT seleCTION 10 However, when the arterioportal shunt reaches the contralateral lobar portal vein, it is a relative contraindication for TARE. On CT and magnetic resonance imaging (MRI) of the hepatic arterial phase, intense contrast enhancement of the portal vein indicates the presence of an arterioportal shunt.…”