Safety of Repeated Radioembolizations in Patients with Advanced Primary and Secondary Liver Tumors and Progressive Disease After First Selective Internal Radiotherapy

Zarva, Alina; Mohnike, Konrad; Damm, Robert; Ruf, Juri; Seidensticker, Ricarda; Ulrich, Gerhard; Seidensticker, Max; Pech, Maciej; Ricke, Jens; Amthauer, Holger

doi:10.2967/jnumed.113.127662

Cited by 33 publications

(19 citation statements)

References 31 publications

(24 reference statements)

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“…In theory, after assessment of these parameters, additional radioembolization may be considered at an early stage, such as directly after administration of the treatment dose. However, the safety of repeated whole-liver radioembolization has not been firmly established yet (54,55).…”

Section: Posttreatment Imaging and Dosimetrymentioning

confidence: 99%

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

et al. 2015

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the status of the current literature regarding new indications for radioembolization; (2) describe standard hepatic vascularization, identify common routes for extrahepatic depositions, and judge when "skeletization" of hepatic arteries could be unnecessary; and (3) appraise the different methods of activity calculation and recognize the strengths and pitfalls of pretreatment and posttreatment dosimetry.Financial Disclosure: Dr. Lam is a consultant/advisor for BTG International and a meeting participant/lecturer for SirTex Medical. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through July 2018.Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization. Several practical issues and recommendations in the application of radioembolization will be discussed, ranging from patient selection to treatment response and future applications.

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Section: Posttreatment Imaging and Dosimetrymentioning

confidence: 99%

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

et al. 2015

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“…Generell ist die Datenlage zu diesem radiobiologischen Aspekt unzureichend, wobei hier diskordant sowohl von einer sicheren Anwendungen [66] als auch von Toxizität [65] berichtet wurde.…”

Section: Vergleich Der Re Mit Daten Der Ebrtunclassified

Dosimetrie bei der Selektiven Internen Radiotherapie (SIRT)

2018

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ZusammenfassungFür die Berechnung der Therapieaktivität im Rahmen der Selektiven Internen Radiotherapie (SIRT oder auch Radioembolisation) existieren unterschiedlich elaborierte Berechnungsmodelle. Diese besitzen empirischen Charakter bzw. basieren auf makroskopischen Ansätzen unter der Annahme einer Gleichverteilung der Mikrosphären und damit der akkumulierten Dosis (MIRD-basierter Modellansatz). Eine Inhomogenität in der Anreicherung des Radioembolisats, welche regulär durch die post-therapeutische Bildgebung beobachtet wird, findet in den Dosierungskonzepten keine Berücksichtigung. Für die weitere Entwicklung wäre es hier wünschenswert, radiobiologische Konzepte stärker zu integrieren und eine Dosierung der Therapieaktivität unter Berücksichtigung der (limitierenden) gewebsspezifischen Toleranzen durchzuführen.Generell sind die Bewertung der Effektivität und der Nebenwirkungen sowie die damit verbundene Definition von Toleranzdosen/Zieldosen schwierig. Die verfügbaren Daten weisen aufgrund der Heterogenität der untersuchten Endpunkte, unterschiedlicher basaler Leberfunktion und individueller Erkrankungshistorien (Vortherapie) eine große Streuung und eine damit verbundene große Unsicherheit auf.

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“…Data on the safety of repeated radioembolization in a territory that has already been treated are mixed (83,84). One study showed an elevated risk of REILD after repeated radioembolization, especially repeated whole-liver radioembolization (83).…”

Section: Repeated Treatmentmentioning

confidence: 99%

“…One study showed an elevated risk of REILD after repeated radioembolization, especially repeated whole-liver radioembolization (83). Another study showed acceptable toxicity when an average of 3 lobar treatments was performed, with 4-6 wk between sequential lobar treatments; when a bilirubin cutoff of 1.75 mg/dL was used for both initial and repeated treatments; and when repeated radioembolization was performed only for patients who initially demonstrated a response to radioembolization (6 wk after treatment) but then later showed disease progression (84).…”

Section: Repeated Treatmentmentioning

confidence: 99%

Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes

2017

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Liver metastases are a major cause of death from colorectal cancer. Intraarterial therapy options for colorectal liver metastases include chemoinfusion via a hepatic arterial pump or port, irinotecan-loaded drug-eluting beads, and radioembolization using Y microspheres. Intraarterial therapy allows the delivery of a high dose of chemotherapy or radiation into liver tumors while minimizing the impact on liver parenchyma and avoiding systemic effects. Specificity in intraarterial therapy can be achieved both through preferential arterial flow to the tumor and through selective catheter positioning. In this review, we discuss indications, contraindications, preprocedure evaluation, activity prescription, follow-up, outcomes, and complications of radioembolization of colorectal liver metastases. Methods for preventing off-target embolization, increasing the specificity of microsphere delivery, and reducing the lung-shunt fraction are discussed. There are 2 types ofY microspheres: resin and glass. Because glass microspheres have a higher activity per particle, they can deliver a particular radiation dose with fewer particles, likely reducing embolic effects. Glass microspheres thus may be more suitable when early stasis or reflux is a concern, in the setting of hepatocellular carcinoma with portal vein invasion, and for radiation segmentectomy. Because resin microspheres have a lower activity per particle, more particles are needed to deliver a particular radiation dose. Resin microspheres thus may be preferable for larger tumors and those with high arterial flow. In addition, resin microspheres have been approved by the U.S. Food and Drug Administration for colorectal liver metastases, whereas institutional review board approval is required before glass microspheres can be used under a compassionate-use or research protocol. Finally, radiation segmentectomy involves delivering a calculated lobar activity of Y microspheres selectively to treat a tumor involving 1 or 2 liver segments. This technique administers a very high radiation dose and effectively causes the ablation of tumors that are too large or are in a location considered unsafe for thermal ablation. The selective delivery spares surrounding normal liver, reducing the risk of liver failure.

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Safety of Repeated Radioembolizations in Patients with Advanced Primary and Secondary Liver Tumors and Progressive Disease After First Selective Internal Radiotherapy

Cited by 33 publications

References 31 publications

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

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

Dosimetrie bei der Selektiven Internen Radiotherapie (SIRT)

Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes

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Safety of Repeated Radioembolizations in Patients with Advanced Primary and Secondary Liver Tumors and Progressive Disease After First Selective Internal Radiotherapy

Cited by 33 publications

References 31 publications

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

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

Dosimetrie bei der Selektiven Internen Radiotherapie (SIRT)

Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes

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

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