Significance of Oral Administration of Sodium Perchlorate in Planning Liver-Directed Radioembolization

Sabet, Amir; Ahmadzadehfar, Hojjat; Muckle, Marianne; Haslerud, Torjan; Wilhelm, Kai; Biersack, Hans‐Jürgen; Ezziddin, Samer

doi:10.2967/jnumed.110.083626

Cited by 33 publications

(22 citation statements)

References 20 publications

(21 reference statements)

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“…All voxels within the volume were summed, without use of a threshold, to prevent underestimation of the activity (and absorbed dose). The total administered activity was estimated by a delineation around the liver, which included the deposition but excluded the kidneys, thyroid, stomach, and lungs, because the microspheres used in radioembolization do not shunt to extrahepatic organs in the same way as free pertechnetate from 99m Tc-MAA (12). The percentage of counts in the deposition relative to the counts in the liver (and deposition) was used to predict the activity in the deposition if 166 Ho were to be used as a scout dose.…”

Section: Analysis Of Deposition: Activity and Volumementioning

confidence: 99%

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

et al. 2015

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Before 166 Ho radioembolization, a small batch of the same type of microspheres is administered as a scout dose instead of the conventional 99m Tc-macroaggregated albumin ( 99m Tc-MAA). The 166 Ho scout dose provides a more accurate and precise lung shunt assessment. However, in contrast to 99m Tc-MAA, an unintended extrahepatic deposition of this β-emitting scout dose could inflict radiation damage, the extent of which we aimed to quantify in this study. Methods: All patients eligible for radioembolization in our institute between January 2011 and March 2014 were reviewed. Of the extrahepatic depositions of 99m Tc-MAA on SPECT, the amount and volume were measured. These were used to calculate the theoretic absorbed dose in the case a 166 Ho scout dose had been used. The extrahepatic activity was measured as the sum of all voxels of the deposition. Volumes were measured using a threshold technique including all voxels from the maximum voxel intensity up to a certain percentage. The threshold needed to obtain the true volume was studied in a phantom study. Results: In the phantom study, a threshold of 40% was found to overestimate the volume, with the consequence of underestimating the absorbed dose. Of 160 patients, 32 patients (34 cases) of extrahepatic deposition were identified. The depositions contained a median of 1.3% (range, 0.1%-19.5%) of the administered activity in a median volume of 6.8 mL (range, 1.1-42 mL). The use of a scout dose of 250 MBq of 166 Ho microspheres in these cases would theoretically have resulted in a median absorbed dose of 6.0 Gy (range, 0.9-374 Gy). The dose exceeded a limit of 49 Gy (reported in 2013) in 2 of 34 cases (5.9%; 95% confidence interval, 0.7%-20.1%) or 2 of 160 (1.3%; 95% confidence interval, 0.1%-4.7%) of all patients. In these 2 patients with a large absorbed dose (112 and 374 Gy), the culprit vessel was identified in 1 case. Conclusion: Extrahepatic deposition of a 166 Ho scout dose seems to be theoretically safe in most patients. Its safety in clinical practice is being evaluated in ongoing clinical trials. Radi oembolization is a minimally invasive treatment for hepatic malignancies. Millions of radioactive microspheres are injected in the hepatic artery to radiate and embolize malignancies (1). Deposition of microspheres in gastrointestinal organs can result in ulceration or inflammation of tissue by a combination of embolization and radiation damage (2-4). To prevent this, vessels leading to gastrointestinal organs may be coil-embolized in patients scheduled for radioembolization treatment, during a pretreatment session using contrastenhanced images (i.e., digital subtraction angiography complemented by C-arm CT) to identify the culprit vessel (5). 99m Tc-macroaggregated albumin ( 99m Tc-MAA) is administered in this pretreatment session to simulate intrahepatic treatment biodistribution and to assess lung shunting and the possibility of extrahepatic deposition of the microspheres (6). This procedure is safe because 99m Tc-MAA emits 140-keV g photons (detecta...

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Section: Analysis Of Deposition: Activity and Volumementioning

confidence: 99%

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

et al. 2015

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“…In 2011, Sabet et al published an article demonstrating that oral administration of sodium perchlorate before the test angiogram with 99m Tc-MAA resulted in effective avoidance of free 99m Tc-pertechnetate concentration and decreased incidence of equivocal findings in the gastroduodenal region (24). …”

Section: Introductionmentioning

confidence: 99%

Side Effects of Yttrium-90 Radioembolization

2014

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Limited therapeutic options are available for hepatic malignancies. Image guided targeted therapies have established their role in management of primary and secondary hepatic malignancies. Radioembolization with yttrium-90 (90Y) microspheres is safe and efficacious for treatment of hepatic malignancies. The tumoricidal effect of radioembolization is predominantly due to radioactivity and not ischemia. This article will present a comprehensive review of the side effects that have been associated with radioembolization using 90Y microspheres. Some of the described side effects are associated with all transarterial procedures. Side effects specific to radioembolization will also be discussed in detail. Methods to decrease the incidence of these potential side effects will also be discussed.

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“…The amount of 99m Tc-MAA was calculated according to the size of the liver lobes, that is, in a typical patient 65 MBq into the right hepatic artery and 35 MBq into the left. Perchlorate (600 mg) was administered orally before angiography to avoid unspecific 99m Tc uptake in the stomach (12). One hour after the injection, planar scintigraphy of the abdomen and thorax was performed to quantify the liver-lung shunting fraction.…”

Section: Angiography Imaging and Image Analysismentioning

confidence: 99%

Predictive Value of ^99mTc-MAA SPECT for ⁹⁰Y-Labeled Resin Microsphere Distribution in Radioembolization of Primary and Secondary Hepatic Tumors

Ilhan¹,

Goritschan²,

Paprottka³

et al. 2015

J Nucl Med

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This study analyzed the predictive value of 99m Tc-labeled macroaggregated albumin ( 99m Tc-MAA) SPECT for 90 Y-labeled resin microsphere therapy (radioembolization) by comparing uptake on pretherapeutic 99m Tc-MAA SPECT with uptake on posttherapeutic 90 Y-bremsstrahlung SPECT. Methods: We included 502 patients (55% male; mean age ± SD, 62 ± 11 y) who underwent radioembolization between 2005 and 2013 because of primary or secondary liver malignancies (colorectal cancer [n 5 195, 38 Y-bremsstrahlung scans were used to quantify mean counts per pixel and evaluate the mean tumor-to-background ratio (TBR). Data were given as mean ± SD. Additionally, uptake in lesions on 99m Tc-MAA and 90 Y-bremsstrahlung scans was graded visually as homogeneously higher than (grade 1), heterogeneously higher than (grade 2), equal to (grade 3), or lower than (grade 4) uptake in normal liver tissue. The Mann-Whitney U test and Spearman correlation were used to evaluate statistically significant differences between 99m Tc-MAA and 90 Y-bremsstrahlung SPECT. Results: In total, 1,008 lesions were analyzed. Of the 23% (230/ 1,008) of lesions that had grade 1 uptake on 99m Tc-MAA SPECT, 81% (186/230) remained grade 1 after radioembolization whereas 16% (37/230) were grade 2. Of the lesions with grade 2 uptake on 99m Tc-MAA SPECT, 16% had grade 1 uptake and 82% grade 2 uptake after radioembolization. Of the lesions with grade 3 uptake, however, 27% had grade 1 uptake and 47% grade 2 uptake after radioembolization. Even among the lesions with grade 4 uptake on 99m Tc-MAA SPECT, 21% had grade 1 uptake and 46% grade 2 uptake after radioembolization. The mean TBR on 99m Tc-MAA and 90 Y-bremsstrahlung SPECT showed a significant, though low, correlation in the total population (r 5 0.26; P , 0.001) and in hepatocellular carcinoma (r 5 0.4; P , 0.001), cholangiocellular carcinoma (r 5 0.3; P , 0.05), breast cancer (r 5 0.3; P , 0.001), colorectal cancer (r 5 0.2; P , 0.001), and neuroendocrine tumors (r 5 0.2; P , 0.01). Conclusion: Although significant for most lesions, the correlation between 99m Tc-MAA and 90 Y-microsphere mean TBR was low. Classifying uptake into 4 grades revealed that lesions with high uptake on 99m Tc-MAA SPECT maintain high uptake within radioembolization. More than 60% of lesions with a pretherapeutically lower uptake than in healthy liver tissue, however, showed high uptake within radioembolization. Patients with low tumor uptake on pretherapeutic 99m Tc-MAA imaging should not be excluded from radioembolization.

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Significance of Oral Administration of Sodium Perchlorate in Planning Liver-Directed Radioembolization

Cited by 33 publications

References 20 publications

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Side Effects of Yttrium-90 Radioembolization

Predictive Value of ^99mTc-MAA SPECT for ⁹⁰Y-Labeled Resin Microsphere Distribution in Radioembolization of Primary and Secondary Hepatic Tumors

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Significance of Oral Administration of Sodium Perchlorate in Planning Liver-Directed Radioembolization

Cited by 33 publications

References 20 publications

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

Side Effects of Yttrium-90 Radioembolization

Predictive Value of 99mTc-MAA SPECT for 90Y-Labeled Resin Microsphere Distribution in Radioembolization of Primary and Secondary Hepatic Tumors

Contact Info

Product

Resources

About

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Predictive Value of ^99mTc-MAA SPECT for ⁹⁰Y-Labeled Resin Microsphere Distribution in Radioembolization of Primary and Secondary Hepatic Tumors