Streamlining radioembolization in UNOS T1/T2 hepatocellular carcinoma by eliminating lung shunt estimation

Surveillance and Monitoring of Hepatocellular Carcinoma During the COVID-19 Pandemic

“…Patients scheduled for Y-90 radioembolization commonly undergo angiography 1-2 weeks prior to treatment to evaluate for significant shunting that would make patients ineligible for Y-90 therapy. However, lung shunt fraction is negligible in early-stage patients receiving segmental Y-90 so this step may be eliminated, 55 which would reduce health care utilization and potential COVID-19 exposure. There is concern for serious COVID-19 infection in those receiving conventional transarterial chemoembolization (cTACE) (with cytotoxic agents) because of systemic absorption with increased myelosuppression, and therefore the International Liver Cancer Association recommends other forms of LRT over cTACE (eg, bland embolization, drug-eluting bead-TACE, Y-90).…”

Radiation Therapies for the Treatment of Hepatocellular Carcinoma

“…The principle behind TARE infusion is intra‐arterial delivery of high‐dose ionizing radiation into the tumor bed via the hepatic artery, with continuous radiation exposure as the yttrium‐90 decays. TARE is typically conducted in a two‐step process, with a 99m technecium‐labeled macroaggregated albumin mapping study prior to treatment to evaluate possible deposition of microspheres in extrahepatic sites, although patients with early‐stage HCC (T1 or T2) may be able to avoid the mapping procedure 4 …”

Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

“…Locoregional therapies 50 Because a low risk of radiation pneumonitis has been reported, macro aggregated albumin scans to estimate lung shunt fractions and lung dose are not required. 50 The availability of these procedures might also depend on the stage of the pandemic each centre is at, and if the centres do such procedures as inpatient or outpatient visits.…”

“…Locoregional therapies 50 Because a low risk of radiation pneumonitis has been reported, macro aggregated albumin scans to estimate lung shunt fractions and lung dose are not required. 50 The availability of these procedures might also depend on the stage of the pandemic each centre is at, and if the centres do such procedures as inpatient or outpatient visits. Therefore, if certain interventional resources are diminished or unavailable, the use of radiotherapy in tumours equal to and less than 10 cm in diameter (ie, those most likely to be controlled) 51 could be considered, so long as liver dose-volume constraints are met.…”