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

Abstract

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.

Insights into the Dose–Response Relationship of Radioembolization with Resin 90Y-Microspheres: A Prospective Cohort Study in Patients with Colorectal Cancer Liver Metastases

“…Now, several large, multicenter randomized controlled trials are investigating the benefit of adding radioembolization treatment to systemic therapy in the first-and second-line treatment of CRLM (12). These trials have the potential to define the role of radioembolization in the treatment paradigm for CRLM.…”

Simultaneous fluoroscopic and nuclear imaging: impact of collimator choice on nuclear image quality

“…In the scout step of the procedure, 150 MBq of 99m Tc‐labeled macroaggregated albumin (MAA) is used. All activity is expected to lodge in the liver (predominantly in the tumors) in a volume of typically 1000 – 1500 milliliter …”

Treating hepatocellular carcinoma with 90Y-bearing microspheres: a review

“…Currently, little is known about the maximum tolerable dose of non-tumor liver parenchyma in SIRT. Although there have been recommendations to set non-tumor dose limits as low as 70 Gy in non-cirrhotic livers and 50 Gy in cirrhotic livers [21], these limits are still arbitrarily defined and need to be confirmed in prospective studies [22]. …”

“…The main limitation of this method is the absence of target volume in the calculation, resulting in possible under-treatment (for example, a small patient with a large liver) or over-treatment (a large patient with a small liver) [26, 28]. In addition, the differences of individual intrahepatic distribution of radioactivity in tumor and non-tumor livers are not considered, which is also disadvantage for patients with hyper- or hypo-vascular tumors [22]. …”