The Impact of an Antireflux Catheter on Target Volume Particulate Distribution in Liver-Directed Embolotherapy: A Pilot Study

Pasciak, Alexander S.; McElmurray, James H.; Bourgeois, Austin C.; Heidel, R. Eric; Bradley, Yong C.

doi:10.1016/j.jvir.2015.01.029

Cited by 36 publications

(22 citation statements)

References 18 publications

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“…Once the therapeutic microsphere distribution can be predicted, pretreatment activity calculation can be tailored to the individual patient with the previously described artery-specific partition model, yielding a distribution-specific maximum tolerable treatment activity (14). Furthermore, different strategies may improve tumor targeting during the treatment procedure itself, including the use of a vasoconstrictor or another catheter type to affect hemodynamics (15,16). A better understanding of the dose-response relationship also creates a framework for the measurement of technical success after treatment, both in clinical practice and in research.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Randomized controlled trials are investigating the benefit of hepatic radioembolization added to systemic therapy in the first-and second-line treatment of patients with colorectal liver metastases (CRLM). Remarkably, administered activity may still be suboptimal, because a dose-response relationship has not been defined. The purpose of this study was to characterize the relationship between tumor-absorbed dose and response after 90 Y radioembolization treatment for CRLM. Methods: Thirty patients with unresectable chemorefractory CRLM were treated with resin 90 Y-microspheres in a prospective phase II clinical trial. Tumor-absorbed dose was quantified on 90 Y PET. Metabolic tumor activity, defined as tumor lesion glycolysis (TLG*) on 18 F-FDG PET, was measured at baseline and 1 mo after treatment. The relationship between tumor-absorbed dose and posttreatment metabolic activity was assessed per metastasis with a linear mixed-effects regression model. Results: Treated metastases (n 5 133) were identified. The mean tumorabsorbed dose was 51 ± 28 Gy (range, 7-174 Gy). A 50% reduction in TLG* was achieved in 46% of metastases and in 11 of 30 (37%) patients for the sum of metastases. The latter was associated with a prolonged median overall survival (11.6 vs. 6.6 mo, P 5 0.02). A strong and statistically significant dose-response relationship was found (P , 0.001). The dose effect depended on baseline TLG* (P , 0.01). The effective tumor-absorbed dose was conservatively estimated at a minimum of 40-60 Gy. Conclusion: A strong dose-response relationship exists for the treatment of CRLM with resin microsphere 90 Y radioembolization. Treatment efficacy is, however, still limited, because the currently used pretreatment activity calculation methods curb potentially achievable tumor-absorbed dose values. A more personalized approach to radioembolization is required before concluding on its clinical potential.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…If there is a risk of extrahepatic perfusion, then off-target vessels are usually coil embolized during treatment instead of during mapping to reduce the risk of recanalization or formation of arterial collateral vessels in the interim (46). An antireflux catheter or sublobar superselective administration technique can be used to reduce reflux into off-target vessels, especially when coil embolization is not feasible or desirable (47).…”

Section: Techniquementioning

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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“…This may simply be repositioning of a catheter on the basis of physician experience or imaging findings, or it could eventually include integration of corollary techniques such as C-arm cone-beam CT scanning (5) or optical imaging (46). This term would also include embolization of nontarget vessels such as the gastroduodenal or right gastric arteries during radioembolization, particle embolization to decrease arterioportal shunting during chemoembolization of a hepatocellular carcinoma (HCC), use of an antireflux catheter (47,48), or other techniques (49) to ensure appropriate therapeutic agent dissemination.…”

Section: Therapy Controlmentioning

confidence: 99%

Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria

Gaba

Lewandowski

Hickey

et al. 2016

Journal of Vascular and Interventional Radiology

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CR = complete response, EASL ¼ European Association for the Study of the Liver, HCC = hepatocellular carcinoma, MAA = macroaggregated albumin, mRECIST = modified Response Evaluation Criteria In Solid Tumors, PET = positron emission tomography, PFS = progression-free survival, PD = progressive disease, PR = partial response, RECIST = Response Evaluation Criteria In Solid Tumors, SD = stable disease, TTP = time to progression, WHO = World Health Organization Transcatheter liver-directed intraarterial therapies-such as embolization, chemoembolization, and radioembolization-represent fundamental interventional oncology procedures that have gained international acceptance for the treatment of primary and secondary hepatic malignancies. The growing use of these interventions mandates objective and formalized criteria for the consistent reporting of research outcomes to optimize accurate communication in the field and to facilitate valid comparison of technologies and results across clinical studies. Accordingly, a panel of experts was convened in 2007 and again in 2009 to develop standard terminology for transcatheter therapy (1,2). The evolution and advancement of the field of transcatheter therapy for hepatic malignancy since that time has seen the introduction of new delivery vehicles (3,4), expanded use of novel targeting technologies (5), and development of improved response assessment criteria (6), all of which must be incorporated into updated Research Reporting Standards to ensure that standard definitions, terms, principles, and benchmarks properly align with current interventional oncologic clinical practice. Thus, the present independent review, revision, and ratification of the previous report by the Society of Interventional Radiology (SIR) Interventional Oncology Service Line and Technology Assessment Committee (1,2) represents a continuation of the collaborative initiative to consolidate and unite all investigators and clinicians practicing interventional oncology by providing a common language to describe transcatheter therapies and outcomes. CLASSIFICATION OF THERAPIES Image-Guided Transcatheter Tumor Therapy The term "image-guided transcatheter tumor therapy" is defined as the intravascular delivery of therapeutic agents via selective catheter placement with imaging guidance for the treatment of malignancy. Currently, various devices-such as embolic or drug-eluting particles, chemotherapeutic medications, or radioactive materials-are injected via tumor-feeding vessels with intent to achieve cytoreduction through focused delivery and deposition of high concentrations of therapeutic agent as well as ischemic devascularization (7-14). Therapeutic material may eventually include biologically active agents, chemical mediators of cell function and/or the tumor microenvironment, viral vectors, genetic material, nanoparticles, or other agents not yet developed or described. The term "transcatheter" aims to distinguish these therapies from other treatments that are applied orally or via a systemic intravenous ...

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The Impact of an Antireflux Catheter on Target Volume Particulate Distribution in Liver-Directed Embolotherapy: A Pilot Study

Cited by 36 publications

References 18 publications

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

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

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

Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria

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The Impact of an Antireflux Catheter on Target Volume Particulate Distribution in Liver-Directed Embolotherapy: A Pilot Study

Cited by 36 publications

References 18 publications

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

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

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

Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology and Reporting Criteria

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Product

Resources

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

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