Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

Abstract

Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including 99mTc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall 99mTc-HSAM accumulation. The other four patients presented with an abdominal wall 99mTc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall 99mTc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

“…One of the first pioneers in performing radioembolization with 90 Y microspheres for colorectal cancer (CRC) hepatic metastases was Ariel, 2 a surgeon from New York, in animal experiments and subsequently in two human volunteers. Nolan and Grady 3 then described the use of 90 Y oxide to treat hepatocellular carcinoma (HCC) in humans. Subsequent clinical trials involved several successful treatments of metastatic CRC to the liver.…”

“…9 Metastatic liver tumours .3 mm derive 80-100% of their blood supply from arterial rather than portal hepatic circulation. 10 These concepts are the basis for intra-arterial administration of 90 Y microspheres. Two parts are present in this radioembolization procedure: embolization and brachytherapy.…”

“…Although the terms "selective internal radiation therapy" and "radioembolization" have been used synonymously, the Society of Interventional Radiology (Fairfax, VA) prefers the term "radioembolization". 12 Yttrium-90 properties and microspheres 90 Y is a beta emitter with a 64.2-h physical half-life, in which up to 94% of the 90 Y microspheres radiation dose can be delivered during the first 11 days following treatment, after which it decays into stable zirconium. 90 Y microspheres entrapped in the microvasculature of the liver emit b-radiation with a mean energy of 0.94 MeV, maximum energy of 2.26 MeV, mean tissue penetration of 2.5 mm and maximum penetration of 11 mm.…”

“…Liver tumours, both primary and metastatic, form a large proportion of solid tumours with a variety of therapeutic options. Radioembolization with the radioisotope 90 Y is a procedure in which resin or glass microspheres containing 90 Y are administered directly into the hepatic arteries which supply the hepatic tumour. 1…”

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 2: Abdominal Parenchymal Organs

“…Since the falciform artery often originates far in the periphery of the hepatic artery, selective occlusion is often not possible. Schelhorn et al examined 19 SIRT patients with an open falciform artery [15]. It was able to be shown that a large-caliber, open falciform artery is not a contraindication for SIRT.…”