Yttrium-90 Microsphere Therapy for Hepatic Malignancy: Devices, Indications, Technical Considerations, and Potential Complications

Abstract

Management of hepatic malignancies is a ubiquitous medical problem. Surgical resection of primary or metastatic liver cancer, with or without adjuvant chemotherapy, is the most effective method for enhancing survival; however, hepatic malignancies in the vast majority of patients are unresectable both at initial manifestation and at recurrence. In these patients, palliative cytoreductive therapies may help to retard tumor progression and therefore favorably alter the course of the disease. Since hepatic neoplasms are principally supplied by the hepatic artery, various arterially delivered cytotoxic agents have been developed to achieve these objectives. Recently, the Food and Drug Administration approved the transarterial administration of yttrium-90 microspheres for liver-directed therapy. Effective use of these devices requires knowledge of the accumulated clinical experience and a dedicated multidisciplinary effort to ensure optimal outcomes and avoid therapy-specific life-threatening complications.

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

“…This is a rather unexpected finding, because only the glass microspheres are FDA-approved for treating HCC, whereas the resin microspheres are approved for mCRC, not HCC. It may be postulated that this outcome is the consequence of the substantial difference in numbers of microspheres that are infused: a dose of glass microspheres consists of 4 million microspheres, whereas a dose of resin microspheres usually contains 50 million microspheres [42]. It has been reported in the literature that administration of resin microspheres had to be prematurely halted, before the predetermined amount of radioactivity was instilled, due to macroscopic embolization [43].…”

Female Pelvis: Genital Organs

“…The radiological manifestations are similar to RILD manifestations caused by external beam radiation, but affecting only the radioembolization perfusion zone. At CT, hypodense regions appear after radioembolization, appearing heterogeneous when using a low dose regimen (under 100 Gy) (Murthy et al 2005 ). The typical appearance is different in cirrhotic and noncirrhotic livers.…”

An Overview of the Surgical Management of Hepatic Neuroendocrine Metastases

“…Circulatory reflux into the gastroduodenal arteries also increases the risk of irradiation beyond target lesions in the liver. Pretherapeutic technetium99m-( 99m Tc-) labelled macroaggregated albumin (MAA) scans can exclude these conditions [43,44]. Patients who are deemed untreatable on the basis of unacceptably high shunting can actually have their shunts occluded through the temporary inflation of balloons within the hepatic veins, which may then enable radioembolization to occur more safely [50].…”