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Baloji A, Kalra N, Chaluvashetty S, Bhujade H, Chandel K, Duseja A, Taneja S, Gorsi U, Kumar R, Singh H, Sood A, Bhattacharya A, Singh B, Mittal BR, Singh V, Sandhu MS. Efficacy of Yttrium-90 Transarterial Radioembolisation in Advanced Hepatocellular Carcinoma: An Experience With Hybrid Angio-Computed Tomography and Glass Microspheres. J Clin Exp Hepatol 2024; 14:101342. [PMID: 38283702 PMCID: PMC10819781 DOI: 10.1016/j.jceh.2023.101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
Background Hepatocellular carcinoma is one of the most common malignancies worldwide. Transarterial radioembolisation (TARE) involves selective intra-arterial administration of microspheres loaded with a radioactive compound like Yttrium-90 (Y-90). Conventionally, C-arm-based cone-beam computed tomography has been extensively used during TARE. However, angio-computed tomography (CT) is a relatively new modality which combines the advantages of both fluoroscopy and fCT. There is scarce literature detailing the use of angio-CT in Y90 TARE. Methods This was a retrospective study of primary liver cancer cases in which the TARE procedure was done from November 2017 to December 2021. Glass-based Y-90 microspheres were used in all these cases. All the cases were performed in the hybrid angio-CT suite. A single photon emission computed tomography-computed comography (SPECT-CT) done postplanning session determined the lung shunt fraction and confirmed the accurate targeting of the lesion. Postdrug delivery, positron emission tomography-computed tomography (PET-CT) was obtained to confirm the distribution of the Y-90 particles. The technical success, median follow-up, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were recorded. Results A total of 56 hepatocellular carcinoma patients underwent TARE during this period, out of which 36 patients (30 males and 6 females) underwent Y90 TARE. The aetiology of cirrhosis included non-alcoholic steatohepatitis (NASH) (11), hepatitis C (HCV) (11), hepatitis B (HBV) (9), metabolic dysfunction and alcohol-associated liver disease (MetALD) (2), alcoholic liver disease (ALD) (1), cryptogenic (1), and autoimmune hepatitis (AIH) (1). The technical success was 100 % and the median follow-up was 7 months (range: 1-32 months). The median OS was 15 months (range 10.73-19.27 months; 95 % CI) and the median local PFS was 4 months (range 3.03-4.97 months; 95 % CI). The ORR (best response, CR + PR) was 58 %. No major complications were seen in this study. Conclusion TARE is a viable option for liver cancer in all stages, but more so in the advanced stages. The use of angio-CT in TARE aids in the precise delivery of the particles to the tumour and avoids non-target embolisation.
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Affiliation(s)
- Abhiman Baloji
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara Chaluvashetty
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karamvir Chandel
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Baljinder Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant R. Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit S. Sandhu
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Salem R, Padia SA, Lam M, Chiesa C, Haste P, Sangro B, Toskich B, Fowers K, Herman JM, Kappadath SC, Leung T, Sze DY, Kim E, Garin E. Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2023; 50:328-343. [PMID: 36114872 PMCID: PMC9816298 DOI: 10.1007/s00259-022-05956-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE In light of recently published clinical reports and trials, the TheraSphere Global Dosimetry Steering Committee (DSC) reconvened to review new data and to update previously published clinical and dosimetric recommendations for the treatment of hepatocellular carcinoma (HCC). METHODS The TheraSphere Global DSC is comprised of health care providers across multiple disciplines involved in the treatment of HCC with yttrium-90 (Y-90) glass microsphere-based transarterial radioembolization (TARE). Literature published between January 2019 and September 2021 was reviewed, discussed, and adjudicated by the Delphi method. Recommendations included in this updated document incorporate both the results of the literature review and the expert opinion and experience of members of the committee. RESULTS Committee discussion and consensus led to the expansion of recommendations to apply to five common clinical scenarios in patients with HCC to support more individualized efficacious treatment with Y-90 glass microspheres. Existing clinical scenarios were updated to reflect recent developments in dosimetry approaches and broader treatment paradigms evolving for patients presenting with HCC. CONCLUSION Updated consensus recommendations are provided to guide clinical and dosimetric approaches for the use of Y-90 glass microsphere TARE in HCC, accounting for disease presentation, tumor biology, and treatment intent.
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Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paul Haste
- Department of Interventional Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Beau Toskich
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kirk Fowers
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Joseph M Herman
- Department of Radiation Medicine, Northwell Health, New Hyde Park, NY, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Edward Kim
- Department of Interventional Radiology, Mount Sinai, New York City, NY, USA
| | - Etienne Garin
- INSERM, INRA, Centre de Lutte Contre Le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, 35000, Rennes, France
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Santoro M, Della Gala G, Paolani G, Zagni F, Strolin S, Civollani S, Calderoni L, Cappelli A, Mosconi C, Lodi Rizzini E, Tabacchi E, Morganti AG, Fanti S, Golfieri R, Strigari L. A novel tool for motion-related dose inaccuracies reduction in 99mTc-MAA SPECT/CT images for SIRT planning. Phys Med 2022; 98:98-112. [PMID: 35526374 DOI: 10.1016/j.ejmp.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In Selective Internal Radiation Therapy (SIRT), 90Y is administered to primary/secondary hepatic lesions. An accurate pre-treatment planning using 99mTc-MAA SPECT/CT allows the assessment of its feasibility and of the activity to be injected. Unfortunately, SPECT/CT suffers from patient-specific respiratory motion which causes artifacts and absorbed dose inaccuracies. In this study, a data-driven solution was developed to correct the respiratory motion. METHODS The tool realigns the barycenter of SPECT projection images and shifts them to obtain a fine registration with the attenuation map. The tool was validated using a modified dynamic phantom with several breathing patterns. We compared the absorbed dose distributions derived from uncorrected(Dm)/corrected(Dc) images with static ones(Ds) in terms of γ-passing rates, 210 Gy isodose volumes, dose-volume histograms and percentage differences of mean doses (i.e., ΔD¯m and ΔD¯c, respectively). The tool was applied to twelve SIRT patients and the Bland-Altman analysis was performed on mean doses. RESULTS In the phantom study, the agreement between Dc and Ds was higher (γ-passing rates generally > 90%) than Dm and Ds. The isodose volumes in Dc were closer than Dm to Ds, with differences up to 10% and 30% respectively. A reduction from a median ΔD¯m = -19.3% to ΔD¯c = -0.9%, from ΔD¯m = -42.8% to ΔD¯c = -7.0% and from ΔD¯m = 1586% to ΔD¯c = 47.2% was observed in liver-, tumor- and lungs-like structures. The Bland-Altman analysis on patients showed variations (±50 Gy) and (±4 Gy) between D¯c and D¯m of tumor and lungs, respectively. CONCLUSION The proposed tool allowed the correction of 99mTc-MAA SPECT/CT images, improving the accuracy of the absorbed dose distribution.
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Affiliation(s)
- Miriam Santoro
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppe Della Gala
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giulia Paolani
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Zagni
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Strolin
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simona Civollani
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | | | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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Kim GM. Superselective transarterial radioembolization for the treatment of hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gyoung Min Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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6
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Sankhla T, Cheng B, Nezami N, Xing M, Sethi I, Bercu Z, Brandon D, Majdalany B, Schuster DM, Kokabi N. Role of Resin Microsphere Y90 Dosimetry in Predicting Objective Tumor Response, Survival and Treatment Related Toxicity in Surgically Unresectable Colorectal Liver Metastasis: A Retrospective Single Institution Study. Cancers (Basel) 2021; 13:cancers13194908. [PMID: 34638392 PMCID: PMC8508412 DOI: 10.3390/cancers13194908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Colorectal liver metastases are difficult to treat, with only a minority of patients eligible for surgical resection. Yttrium-90 selective internal radiation therapy is an alternative treatment currently used for patients who have progressed on chemotherapy. A technique called dosimetry allows clinicians to analyze how much radiation was delivered to target lesions post-treatment. The aim of this study is to evaluate the relationship of various dosimetric parameters with objective tumor response, overall survival, and treatment related toxicity with the potential goal of optimizing Yttrium-90 treatment in this patient population. Additionally, other potential predictors of survival outcomes, including clinical and demographic factors, were also evaluated. We found that delivering a mean tumor dose ≥100 Gy when using resin microspheres was significantly associated with objective tumor response and prolonged overall survival. In this study, no mean non-tumoral liver dose threshold was found to predict treatment related toxicity. Abstract Purpose: To Evaluate the correlation between tumor dosimetric parameters with objective tumor response (OR) and overall survival (OS) in patients with surgically unresectable colorectal liver metastasis (CRLM) undergoing resin-based Ytrrium-90 selective internal radiation therapy (Y90 SIRT). Materials and Methods: 45 consecutive patients with CRLM underwent resin-based Y90 SIRT in one or both hepatic lobes (66 treated lobes total). Dose volume histograms were created with MIM Sureplan® v.6.9 using post-treatment SPECT/CT. Dosimetry analyses were based on the cumulative volume of the five largest tumors in each treatment session and non-tumoral liver (NTL) dose. Receiver operating characteristic (ROC) curve was used to evaluate tumor dosimetric factors in predicting OR by Response Evaluation Criteria for Solid Tumors at 3 months post-Y90. Additionally, ROC curve was used to evaluate non-tumoral liver dose as a predictor of grade ≥ 3 liver toxicity and radioembolization induced liver disease (REILD) 3 months post Y90. To minimize for potential confounding demographic and clinical factors, univariate and multivariate analysis of survival with mean tumor dose as one of the factors were also performed. Kaplan-Meier estimation was used for OS analysis from initial Y90 SIRT. Results: 26 out of 45 patients had OR with a median OS of 17.2 months versus 6.8 months for patients without OR (p < 0.001). Mean tumor dose (TD) of the five largest tumors was the strongest predictor of OR with an area under the curve of 0.73 (p < 0.001). Minimum TD, and TD to 30%, 50%, and 70% of tumor volume also predicted OR (p’s < 0.05). Mean TD ≥ 100 Gy predicted a significantly prolonged median OS of 19 vs. 11 months for those receiving TD < 100 Gy (p = 0.016). On univariate analysis, mean TD < 100 Gy, presence of any genomic mutation, presence of MAPK pathway mutation, bilobar hepatic metastases and diffuse metastatic disease (>10 lesions per liver lobe) were found to be predictors of shorter median OS. On multivariate analysis, mean TD < 100 Gy, presence of any genomic mutation, and diffuse hepatic metastatic disease were found to be independent predictors of shorter OS. Overall, six (13.3%) patients developed grade ≥ 3 liver toxicity post Y90 of whom two (4.4%) patients developed REILD. No dose threshold predicting grade ≥ 3 liver toxicity or REILD was identified. Conclusions: Mean TD ≥ 100 Gy in patients with unresectable CRLM undergoing resin-based Y90 SIRT predicts OR and prolonged OS.
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Affiliation(s)
- Tina Sankhla
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Bernard Cheng
- Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Nariman Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Minzhi Xing
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Zachary Bercu
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - David Brandon
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Bill Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
| | - David M. Schuster
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (I.S.); (D.B.); (D.M.S.)
| | - Nima Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30308, USA; (T.S.); (N.N.); (M.X.); (Z.B.); (B.M.)
- Emory University Hospital Midtown, 550 Peachtree Street NE, Atlanta, GA 30308, USA
- Correspondence: ; Tel.: +1-404-686-8715; Fax: +1-404-686-0104
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Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, Salem R, Lewandowski RJ. Evolution of Radioembolization in Treatment of Hepatocellular Carcinoma: A Pictorial Review. Radiographics 2021; 41:1802-1818. [PMID: 34559587 DOI: 10.1148/rg.2021210014] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transarterial radioembolization (TARE) with yttrium 90 has increasingly been performed to treat hepatocellular carcinoma (HCC). TARE was historically used as a palliative lobar therapy for patients with advanced HCC beyond surgical options, ablation, or transarterial chemoembolization, but recent advancements have led to its application across the Barcelona Clinic Liver Cancer staging paradigm. Newer techniques, termed radiation lobectomy and radiation segmentectomy, are being performed before liver resection to facilitate hypertrophy of the future liver remnant, before liver transplant to bridge or downstage to transplant, or as a definite curative treatment. Imaging assessment of therapeutic response to TARE is challenging as the intent of TARE is to deliver local high-dose radiation to tumors through microembolic microspheres, preserving blood flow to promote radiation injury to the tumor. Because of the microembolic nature, early imaging assessment after TARE cannot rely solely on changes in size. Knowledge of the evolving methods of TARE along with the tools to assess posttreatment imaging and response is essential to optimize TARE as a therapeutic option for patients with HCC. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahmed Gabr
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Linda C Kelahan
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahsun Riaz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Riad Salem
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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Aslam A, Kamath A, Spieler B, Maschiocchi M, Sabottke CF, Chernyak V, Lewis SC. Assessing locoregional treatment response to Hepatocellular Carcinoma: comparison of hepatobiliary contrast agents to extracellular contrast agents. Abdom Radiol (NY) 2021; 46:3565-3578. [PMID: 33856509 DOI: 10.1007/s00261-021-03076-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 12/17/2022]
Abstract
Cross-sectional imaging with contrast-enhanced magnetic resonance imaging (MRI) is routinely performed in patients with hepatocellular carcinoma (HCC) to assess tumor response to locoregional therapy (LRT). Current response assessment algorithms, such as the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA), allow assessment using conventional gadolinium-based extracellular contrast agents (ECA) for accurate tumor response assessment following LRT. MRI with hepatobiliary agents (HBA) allows an acquisition of hepatobiliary phase (HBP), which is proven to increase sensitivity for detection of observations in at-risk patients, particularly for findings < 2 cm. The use of HBA is not yet incorporated into the TRA; however, it is increasingly used in clinical practice. Few published studies have evaluated the performance of LI-RADS TRA by applying ancillary features related to HBP that has resulted in category adjustment, enabling more sensitive and unequivocal diagnosis. This may help timely management of viable cases, without a significant loss of specificity in comparison with the ECA-based LI-RADS TRA assessment. In this review, we will describe and compare the imaging appearance of treated HCC on MRI using extracellular and hepatobiliary contrast agents and discuss emerging evidence and pitfalls in the assessment of tumor response following LRT with HBA.
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Affiliation(s)
- Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5030, USA.
| | - Amita Kamath
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Bradley Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Rm 343, New Orleans, LA, 70112, USA
| | - Mark Maschiocchi
- Umass Memorial Medical Center- University Campus, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Carl F Sabottke
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Victoria Chernyak
- Department of Radiology and Urology, Albert Einstein College of Medicine, New York, 10467, USA
| | - Sara C Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mehta N, Parikh ND, Kelley RK, Hameed B, Singal AG. Surveillance and Monitoring of Hepatocellular Carcinoma During the COVID-19 Pandemic. Clin Gastroenterol Hepatol 2021; 19:1520-1530. [PMID: 32652308 PMCID: PMC7342037 DOI: 10.1016/j.cgh.2020.06.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 01/27/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic is expected to have a long-lasting impact on the approach to care for patients at risk for and with hepatocellular carcinoma (HCC) due to the risks from potential exposure and resource reallocation. The goal of this document is to provide recommendations on HCC surveillance and monitoring, including strategies to limit unnecessary exposure while continuing to provide high-quality care for patients. Publications and guidelines pertaining to the management of HCC during COVID-19 were reviewed for recommendations related to surveillance and monitoring practices, and any available guidance was referenced to support the authors' recommendations when applicable. Existing HCC risk stratification models should be utilized to prioritize imaging resources to those patients at highest risk of incident HCC and recurrence following therapy though surveillance can likely continue as before in settings where COVID-19 prevalence is low and adequate protections are in place. Waitlisted patients who will benefit from urgent LT should be prioritized for surveillance whereas it would be reasonable to extend surveillance interval by a short period in HCC patients with lower risk tumor features and those more than 2 years since their last treatment. For patients eligible for systemic therapy, the treatment regimen should be dictated by the risk of COVID-19 associated with route of administration, monitoring and treatment of adverse events, within the context of relative treatment efficacy.
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Affiliation(s)
- Neil Mehta
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California.
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - R. Katie Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Bilal Hameed
- Division of Gastroenterology, University of California, San Francisco, San Francisco, California
| | - Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center, Dallas, Texas
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10
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Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3596-3614. [PMID: 33909092 DOI: 10.1007/s00261-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/01/2021] [Accepted: 04/10/2021] [Indexed: 12/17/2022]
Abstract
Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.
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11
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King MJ, Tong A, Dane B, Huang C, Zhan C, Shanbhogue K. Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes. Eur J Radiol 2020; 133:109351. [DOI: 10.1016/j.ejrad.2020.109351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
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12
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Abstract
Neuroendocrine neoplasms are a heterogeneous group of tumors arising from cells distributed throughout the body. Local and regional disease is managed with surgical resection; however, treatment of higher-grade neuroendocrine tumors (NETs), unresectable or metastatic disease is complex involving a combination of systemic targeted agents, transarterial embolization, and peptide receptor targeted therapies and is discussed in detail. The most important concept in modern NET workup is that an optimal diagnostic strategy requires combination of both anatomic and functional imaging modalities. NETs often present with unknown primary site of disease, and 68Ga-DOTATATE PET can now diagnose these lesions with great sensitivity.
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Affiliation(s)
- Agata E Migut
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Harmeet Kaur
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA; Department of Interventional Radiology, 1400 Pressler Street, Unit 1471, Houston, TX 77030, USA.
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13
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Establishment and validation of a risk prediction model in patients with hepatocellular carcinoma treated with transarterial radioembolization. Eur J Gastroenterol Hepatol 2020; 32:739-747. [PMID: 31764406 DOI: 10.1097/meg.0000000000001585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIMS Few studies have reported the treatment outcomes of transarterial radioembolization (TARE) using yttrium-90 (Y) for hepatocellular carcinoma (HCC). We established and validated a new risk prediction model for patients with HCC treated with TARE. METHODS Between 2010 and 2017, 113 and 35 patients with intrahepatic HCC treated with TARE were selected for the training and validation cohorts, respectively. The modified response evaluation criteria in solid tumors (mRECIST) were used for response evaluation. RESULTS In the training cohort, the median age was 64.1 years (92 males and 21 females) and the mean survival after TARE was 50.3 months. The cumulative survival rates at six and 12 months were 92.0 and 84.0%, respectively. A new risk prediction model for patients with HCC treated with TARE (Y-scoring system) was established from the training cohort using five independent baseline variables [serum albumin < 3.5 g/dL, hazard ratio = 5.446; alpha-fetoprotein > 200 ng/mL (hazard ratio = 5.071); tumor number ≥ 3 (hazard ratio = 2.933); portal vein thrombosis (hazard ratio = 4.915); and hepatic vein invasion (hazard ratio = 8.500)] and two on-treatment variables [no des-gamma-carboxy prothrombin response (hazard ratio = 15.346) and progressive disease at three months (hazard ratio = 4.154)] for mortality (all P < 0.05). The predictive accuracy of the Y-scoring system was acceptable to predict six [area under the curve (AUC) = 0.845], nine (AUC = 0.868), and 12-month mortality (AUC = 0.886) (all P < 0.05). The predictive accuracy of the system was similarly maintained in the validation cohort (AUC 0.737-0.901 at 6-12 months). CONCLUSION Our new risk prediction model can be used to stratify different prognoses in patients with HCC treated with TARE. Validation studies are required.
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14
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Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors. Radiographics 2020; 39:578-595. [PMID: 30844345 DOI: 10.1148/rg.2019180095] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transarterial radioembolization (TARE), also called radioembolization or selective internal radiation therapy, is an interventional radiology technique used to treat primary liver tumors and liver metastases. The aim of this therapy is to deliver tumoricidal doses of radiation to liver tumors while selecting a safe radiation dose limit for nontumoral liver and lung tissue. Hence, correct treatment planning is essential to obtaining good results. However, this treatment invariably results in some degree of irradiation of normal liver parenchyma, inducing different radiologic findings that may affect follow-up image interpretation. When evaluating treatment response, the treated area size, tumor necrosis, devascularization, and changes seen at functional MRI must be taken into account. Unlike with other interventional procedures, with TARE, it can take several months for the tumor response to become evident. Ideally, responding lesions will show reduced size and decreased enhancement 3-6 months after treatment. In addition, during follow-up, there are many imaging findings related to the procedure itself (eg, peritumoral edema, inflammation, ring enhancement, hepatic fibrosis, and capsular retraction) that can make image interpretation and response evaluation difficult. Possible complications, either hepatic or extrahepatic, also can occur and include biliary injuries, hepatic abscess, radioembolization-induced liver disease, and radiation pneumonitis or dermatitis. A complete understanding of these possible posttreatment changes is essential for correct radiologic interpretations during the follow-up of patients who have undergone TARE. ©RSNA, 2019.
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Affiliation(s)
- Juan C Spina
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Isabel Hume
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ana Pelaez
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Oscar Peralta
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Marcos Quadrelli
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ricardo Garcia Monaco
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
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15
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Voizard N, Cerny M, Assad A, Billiard JS, Olivié D, Perreault P, Kielar A, Do RKG, Yokoo T, Sirlin CB, Tang A. Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review. Insights Imaging 2019; 10:121. [PMID: 31853668 PMCID: PMC6920285 DOI: 10.1186/s13244-019-0801-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) play critical roles for assessing treatment response of hepatocellular carcinoma (HCC) after locoregional therapy. Interpretation is challenging because posttreatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. To help radiologists interpret and report treatment response in a clear, simple, and standardized manner, the Liver Imaging Reporting and Data System (LI-RADS) has developed a Treatment Response (LR-TR) algorithm. Introduced in 2017, the system provides criteria to categorize response of HCC to locoregional treatment (e.g., chemical ablation, energy-based ablation, transcatheter therapy, and radiation therapy). LR-TR categories include Nonevaluable, Nonviable, Equivocal, and Viable. LR-TR does not apply to patients on systemic therapies. This article reviews the LR-TR algorithm; discusses locoregional therapies for HCC, treatment concepts, and expected posttreatment findings; and illustrates LI-RADS treatment response assessment with CT and MRI.
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Affiliation(s)
- Nicolas Voizard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Milena Cerny
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anis Assad
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Ania Kielar
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - An Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Canada.
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16
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Peltek OO, Muslimov AR, Zyuzin MV, Timin AS. Current outlook on radionuclide delivery systems: from design consideration to translation into clinics. J Nanobiotechnology 2019; 17:90. [PMID: 31434562 PMCID: PMC6704557 DOI: 10.1186/s12951-019-0524-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Radiopharmaceuticals have proven to be effective agents, since they can be successfully applied for both diagnostics and therapy. Effective application of relevant radionuclides in pre-clinical and clinical studies depends on the choice of a sufficient delivery platform. Herein, we provide a comprehensive review on the most relevant aspects in radionuclide delivery using the most employed carrier systems, including, (i) monoclonal antibodies and their fragments, (ii) organic and (iii) inorganic nanoparticles, and (iv) microspheres. This review offers an extensive analysis of radionuclide delivery systems, the approaches of their modification and radiolabeling strategies with the further prospects of their implementation in multimodal imaging and disease curing. Finally, the comparative outlook on the carriers and radionuclide choice, as well as on the targeting efficiency of the developed systems is discussed.
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Affiliation(s)
- Oleksii O Peltek
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public Health, Leningradskaya Street 70 Pesochny, Saint-Petersburg, 197758, Russian Federation
| | - Albert R Muslimov
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public Health, Leningradskaya Street 70 Pesochny, Saint-Petersburg, 197758, Russian Federation
| | - Mikhail V Zyuzin
- Faculty of Physics and Engineering, ITMO University, St. Petersburg, 197101, Russia
| | - Alexander S Timin
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public Health, Leningradskaya Street 70 Pesochny, Saint-Petersburg, 197758, Russian Federation.
- Research School of Chemical and Biomedical Engineering, National Research Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050, Russia.
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17
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Hu J, Albadawi H, Oklu R, Chong BW, Deipolyi AR, Sheth RA, Khademhosseini A. Advances in Biomaterials and Technologies for Vascular Embolization. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1901071. [PMID: 31168915 PMCID: PMC7014563 DOI: 10.1002/adma.201901071] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Indexed: 05/03/2023]
Abstract
Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
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Affiliation(s)
- Jingjie Hu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Brian W Chong
- Departments of Radiology and Neurological Surgery, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Amy R. Deipolyi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, 1275 York Avenue, New York, New York 10065, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Radiological Sciences, Department of Chemical and Biomolecular Engineering, Center for Minimally Invasive Therapeutics, California Nanosystems Institute, University of California, 410 Westwood Plaza, Los Angeles, California 90095, USA
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18
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Salem R, Padia SA, Lam M, Bell J, Chiesa C, Fowers K, Hamilton B, Herman J, Kappadath SC, Leung T, Portelance L, Sze D, Garin E. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging 2019; 46:1695-1704. [PMID: 31098749 DOI: 10.1007/s00259-019-04340-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/17/2019] [Indexed: 12/22/2022]
Abstract
The TheraSphere Global Dosimetry Steering Committee was formed in 2017 by BTG International to review existing data and address gaps in knowledge related to dosimetry. This committee is comprised of health care providers with diverse areas of expertise and perspectives on radiation dosimetry. The goal of these recommendations is to optimize glass microspheres radiation therapy for hepatocellular carcinoma while accounting for variables including disease presentation, tumour vascularity, liver function, and curative/palliative intent. The recommendations aim to unify glass microsphere users behind standardized dosimetry methodology that is simple, reproducible and supported by clinical data, with the overarching goal of improving clinical outcomes and advancing the knowledge of dosimetry.
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Affiliation(s)
- Riad Salem
- Department of Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
| | - Siddharth A Padia
- Department of Radiology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Marnix Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jon Bell
- Department of Radiology, The Christie, Manchester, UK
| | - Carlo Chiesa
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy
| | - Kirk Fowers
- BTG International, West Conshohocken, PA, USA
| | | | - Joseph Herman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Leung
- Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | | | - Daniel Sze
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Etienne Garin
- Univ Rennes, INSERM, INRA, Centre de Lutte contre le Cancer Eugène Marquis, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France
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19
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Patella F, Pesapane F, Fumarola E, Zannoni S, Brambillasca P, Emili I, Costa G, Anderson V, Levy EB, Carrafiello G, Wood BJ. Assessment of the response of hepatocellular carcinoma to interventional radiology treatments. Future Oncol 2019; 15:1791-1804. [PMID: 31044615 DOI: 10.2217/fon-2018-0747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
According to Barcelona Clinic Liver Cancer (BCLC) guidelines, interventional radiology procedures are valuable treatment options for many hepatocellular carcinomas (HCCs) that are not amenable to resection or transplantation. Accurate assessment of the efficacy of therapies at earlier stages enables completion of treatment, optimal follow-up and to prevent potentially unnecessary treatments, side effects and costly failure. The goal of this review is to summarize and describe the radiological strategies that have been proposed to predict survival and to stratify HCC responses after interventional radiology therapies. New techniques currently in development are also described.
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Affiliation(s)
- Francesca Patella
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Filippo Pesapane
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enrico Fumarola
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stefania Zannoni
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | - Ilaria Emili
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Guido Costa
- Università degli Studi di Milano, Postgraduate School of General Surgery, Milan, Italy
| | - Victoria Anderson
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Elliot B Levy
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
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20
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Panick CE, Ward RD, Coppa C, Liu PS. Hepatic capsular retraction: An updated MR imaging review. Eur J Radiol 2019; 113:15-23. [DOI: 10.1016/j.ejrad.2019.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
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21
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Hodgson A, Almansouri Z, Adeyi O, Fischer SE. Gross and microscopic changes of liver neoplasms and background hepatic structures following neoadjuvant therapy. J Clin Pathol 2019; 72:112-119. [PMID: 30670563 DOI: 10.1136/jclinpath-2018-205596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 01/03/2023]
Abstract
Liver transplantation is a surgical option with curative intent used in the management of some cases of hepatocellular carcinoma and cholangiocarcinoma (hilar, rarely intrahepatic). A number of different therapeutic modalities including ablative techniques, arterially directed therapies, radiation and chemotherapy are used in the neoadjuvant setting prior to liver transplantation with the goals of preventing tumour progression, decreasing post-transplant recurrence and possibly downstaging patients with tumour burden beyond what is acceptable by current transplant criteria. Pathologists evaluating hepatic explants must be aware of these neoadjuvant therapies and the alterations induced by them in both tumourous and non-tumourous tissue. In this review, we discuss common neoadjuvant therapies used in in this setting, as well as the gross and microscopic changes induced by these presurgical treatments within hepatic neoplasms as well as the background hepatic parenchyma and nearby structures. Select secondary tumours involving the liver which are pretreated will also be discussed. Finally, proper reporting of these changes will be mentioned.
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Affiliation(s)
- Anjelica Hodgson
- Department of Pathobiology and Laboratory Medicine, The University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Zuhoor Almansouri
- Department of Pathobiology and Laboratory Medicine, The University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Oyedele Adeyi
- Department of Pathobiology and Laboratory Medicine, The University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Sandra E Fischer
- Department of Pathobiology and Laboratory Medicine, The University of Toronto, Toronto, Ontario, Canada .,Department of Pathology, University Health Network, Toronto, Ontario, Canada
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22
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Allimant C, Kafrouni M, Delicque J, Ilonca D, Cassinotto C, Assenat E, Ursic-Bedoya J, Pageaux GP, Mariano-Goulart D, Aho S, Guiu B. Tumor Targeting and Three-Dimensional Voxel-Based Dosimetry to Predict Tumor Response, Toxicity, and Survival after Yttrium-90 Resin Microsphere Radioembolization in Hepatocellular Carcinoma. J Vasc Interv Radiol 2018; 29:1662-1670.e4. [DOI: 10.1016/j.jvir.2018.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/21/2022] Open
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23
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Darnell A, Belmonte E, Reig M, Brú C. Evaluating the response to locoregional and systemic treatment for hepatocellular carcinoma. RADIOLOGIA 2018; 60:424-436. [PMID: 30196841 DOI: 10.1016/j.rx.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/14/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
Evaluating the response to different treatments is a decisive factor in the clinical management of patients with hepatocellular carcinoma because it can determine the efficacy of the treatment and because it can detect the recurrence of treated tumors or the appearance of new lesions that can be candidates for new treatments. When locoregional treatments that induce necrosis or molecular therapies are applied, the treated lesions usually change their behavior on imaging studies. It is important to point out that the size of the lesions does not usually decrease, at least initially, and some lesions can even appear to increase in size. For this reason, it is essential to know the mechanisms of action for each treatment applied and the spectrum of findings that these treatments can cause in the different imaging techniques used to assess the response.
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Affiliation(s)
- A Darnell
- Radiología abdominal, CDI, Unidad de Oncología Hepática, (Barcelona Clinic Liver Cancer), Hospital Clinic, Universitat de Barcelona, Barcelona, España.
| | - E Belmonte
- Radiología abdominal, CDI, Unidad de Oncología Hepática, (Barcelona Clinic Liver Cancer), Hospital Clinic, Universitat de Barcelona, Barcelona, España
| | - M Reig
- Servicio de Hepatología, Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Hospital Clínic, Barcelona. IDIBAPS, Universitat de Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | - C Brú
- Radiología abdominal, CDI, Unidad de Oncología Hepática (Barcelona Clinic Liver Cancer), Hospital Clínic, Barcelona. IDIBAPS, Universitat de Barcelona, Barcelona, España
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24
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Radioembolization Versus Bland Embolization for Hepatic Metastases from Small Intestinal Neuroendocrine Tumors: Short-Term Results of a Randomized Clinical Trial. World J Surg 2018; 42:506-513. [PMID: 29167951 PMCID: PMC5762793 DOI: 10.1007/s00268-017-4324-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Radioembolization (RE) with intra-arterial administration of 90Y microspheres is a promising technique for the treatment of liver metastases from small intestinal neuroendocrine tumors (SI-NET) not amenable to surgery or local ablation. However, studies comparing RE to other loco-regional therapies are lacking. The aim of this randomized study was to compare the therapeutic response and safety after RE and bland hepatic arterial embolization (HAE), and to investigate early therapy-induced changes with diffusion-weighted MRI (DWI-MRI). Methods Eleven patients were included in a prospective randomized controlled pilot study, six assigned to RE and five to HAE. Response according to RECIST 1.1 using MRI or CT at 3 and 6 months post-treatment was recorded as well as changes in DWI-MRI parameters after 1 month. Data on biochemical tumor response, toxicity, and side effects were also collected. Results Three months after treatment, all patients in the HAE group showed partial response according to RECIST while none in the RE group did (p = 0.0022). After 6 months, the response rates were 4/5 (80%) and 2/6 (33%) in the HAE and RE groups, respectively (NS). DWI-MRI metrics could not predict RECIST response, but lower pretreatment ADC(120–800) and larger ADC(0–800) increase at 1 month were related to larger decrease in tumor diameter when all tumors were counted. Conclusion HAE resulted in significantly higher RECIST response after 3 months, but no difference compared to RE remained after 6 months. These preliminary findings indicate that HAE remains a safe option for the treatment of liver metastases from SI-NET, and further studies are needed to establish the role of RE and the predictive value of MR-DWI. Electronic supplementary material The online version of this article (10.1007/s00268-017-4324-9) contains supplementary material, which is available to authorized users.
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Voutsinas N, Lekperic S, Barazani S, Titano JJ, Heiba SI, Kim E. Treatment of Primary Liver Tumors and Liver Metastases, Part 1: Nuclear Medicine Techniques. J Nucl Med 2018; 59:1649-1654. [PMID: 30072501 DOI: 10.2967/jnumed.116.186346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/18/2018] [Indexed: 12/14/2022] Open
Abstract
90Y radioembolization is an increasingly used treatment for both primary and metastatic malignancy in the liver. Understanding the biophysical properties, dosing concerns, and imaging appearance of this treatment is important for interventional radiologists and nuclear medicine physicians to provide important therapy. 90Y radioembolization is efficacious and safe, although the possibility of complications does exist. This article provides a comprehensive in-depth discussion about the indications for 90Y radioembolization, reviews the role of preprocedural angiography and 99mTc-macroaggregated albumin scans, illustrates different dosing techniques, compares and contrasts resin and glass microspheres, and describes potential complications.
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Affiliation(s)
- Nicholas Voutsinas
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Safet Lekperic
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Sharon Barazani
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Joseph J Titano
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Sherif I Heiba
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Edward Kim
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Mora RA, Ali R, Gabr A, Abouchaleh N, Asadi AA, Kallini JR, Miller FH, Yaghmai V, Mouli S, Thornburg B, Desai K, Riaz A, Lewandowski RJ, Salem R. Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1723-1738. [PMID: 29147766 DOI: 10.1007/s00261-017-1391-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child-Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.
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Affiliation(s)
- Ronald A Mora
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Rehan Ali
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nadine Abouchaleh
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ali Al Asadi
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Joseph Ralph Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA.
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Adcock CS, Florez E, Zand KA, Patel A, Howard CM, Fatemi A. Assessment of Treatment Response Following Yttrium-90 Transarterial Radioembolization of Liver Malignancies. Cureus 2018; 10:e2895. [PMID: 30175001 PMCID: PMC6116887 DOI: 10.7759/cureus.2895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Transarterial radioembolization using yttrium-90 microspheres is an established and effective treatment for liver malignancies. Determining response to this treatment is difficult due to the radical changes that occur in tissue as a response to radiation. Though accurate assessment of treatment response is paramount for proper patient disposition, there is currently no standardized assessment protocol. Current methods of assessment often consider changes in size, necrosis, vascularity, fluorodeoxyglucose-positron emission tomography FDG-PET metabolic activity, and diffusion using diffusion-weighted magnetic resonance imaging (DWI). Current methods of assessment require a lag time of one to two months post-treatment to determine treatment effectiveness. This delay is a hindrance to obtaining better patient outcomes, giving rise to a need to identify markers for faster determination of treatment efficacy.
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Affiliation(s)
- Charles S Adcock
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Edward Florez
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Kevin A Zand
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Akash Patel
- Interventional Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Candace M Howard
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Ali Fatemi
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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Bargellini I, Crocetti L, Turini FM, Lorenzoni G, Boni G, Traino AC, Caramella D, Cioni R. Response Assessment by Volumetric Iodine Uptake Measurement: Preliminary Experience in Patients with Intermediate-Advanced Hepatocellular Carcinoma Treated with Yttrium-90 Radioembolization. Cardiovasc Intervent Radiol 2018; 41:1373-1383. [PMID: 29654507 DOI: 10.1007/s00270-018-1962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To retrospectively compare early response to yttrium-90 radioembolization (Y90) according to volumetric iodine uptake (VIU) changes, Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) and modified RECIST (mRECIST) in patients with intermediate-advanced hepatocellular carcinoma (HCC) and to explore their association with survival. MATERIALS AND METHODS Twenty-four patients treated with Y90 and evaluated with dual-energy computed tomography before and 6 weeks after treatment were included. VIU was measured on late arterial phase spectral images; 6-week VIU response was defined as: complete response (CR, absence of enhancing tumor), partial response (PR, ≥ 15% VIU reduction), progressive disease (PD, ≥ 10% VIU increase) and stable disease (criteria of CR/PR/PD not met). RECIST 1.1 and mRECIST were evaluated at 6 weeks and 6 months. Responders included CR and PR. Overall survival (OS) was evaluated by Kaplan-Meier analysis and compared by Cox regression analysis. RESULTS High intraobserver and interobserver agreements were observed in VIU measurements (k > 0.98). VIU identified a higher number of responders (18 patients, 75%), compared to RECIST 1.1 (12.5% at 6 weeks and 23.8% at 6 months) and mRECIST (29.2% at 6 weeks and 61.9% at 6 months). There was no significant correlation between OS and RECIST 1.1 (P = 0.45 at 6 weeks; P = 0.21 at 6 months) or mRECIST (P = 0.38 at 6 weeks; P = 0.79 at 6 months); median OS was significantly higher in VIU responders (17.2 months) compared to non-responders (7.4 months) (P = 0.0022; HR 8.85; 95% CI 1.29-88.1). CONCLUSION VIU is highly reproducible; as opposite to mRECIST and RECIST 1.1, early VIU response correlates with OS after Y90 in intermediate-advanced HCC patients.
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Affiliation(s)
- Irene Bargellini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy.
| | - Laura Crocetti
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Francesca Maria Turini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giulia Lorenzoni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Giuseppe Boni
- Department of Nuclear Medicine, Pisa University Hospital, Via Roma 55, 56126, Pisa, Italy
| | | | - Davide Caramella
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126, Pisa, Italy
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Maughan NM, Eldib M, Faul D, Conti M, Elschot M, Knešaurek K, Leek F, Townsend D, DiFilippo FP, Jackson K, Nekolla SG, Lukas M, Tapner M, Parikh PJ, Laforest R. Multi institutional quantitative phantom study of yttrium-90 PET in PET/MRI: the MR-QUEST study. EJNMMI Phys 2018; 5:7. [PMID: 29616365 PMCID: PMC5882483 DOI: 10.1186/s40658-018-0206-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/16/2018] [Indexed: 12/22/2022] Open
Abstract
Background Yttrium-90 (90Y) radioembolization involves the intra-arterial delivery of radioactive microspheres to treat hepatic malignancies. Though this therapy involves careful pre-treatment planning and imaging, little is known about the precise location of the microspheres once they are administered. Recently, there has been growing interest post-radioembolization imaging using positron-emission tomography (PET) for quantitative dosimetry and identifying lesions that may benefit from additional salvage therapy. In this study, we aim to measure the inter-center variability of 90Y PET measurements as measured on PET/MRI in preparation for a multi-institutional prospective phase I/II clinical trial. Eight institutions participated in this study and followed a standardized phantom filling and imaging protocol. The NEMA NU2-2012 body phantom was filled with 3 GBq of 90Y chloride solution. The phantom was imaged for 30 min in listmode on a Siemens Biograph mMR non-TOF PET/MRI scanner at five time points across 10 days (0.3–3.0 GBq). Raw PET data were sent to a central site for image reconstruction and data analysis. Images were reconstructed with optimal parameters determined from a previous study. Volumes of interest (VOIs) matching the known sphere diameters were drawn on the vendor-provided attenuation map and propagated to the PET images. Recovery coefficients (RCs) and coefficient of variation of the RCs (COV) were calculated from these VOIs for each sphere size and activity level. Results Mean RCs ranged from 14.5 to 75.4%, with the lowest mean RC coming from the smallest sphere (10 mm) on the last day of imaging (0.16 MBq/ml) and the highest mean RC coming from the largest sphere (37 mm) on the first day of imaging (2.16 MBq/ml). The smaller spheres tended to exhibit higher COVs. In contrast, the larger spheres tended to exhibit lower COVs. COVs from the 37 mm sphere were < 25.3% in all scans. For scans with ≥ 0.60 MBq/ml, COVs were ≤ 25% in spheres ≥ 22 mm. However, for all other spheres sizes and activity levels, COVs were usually > 25%. Conclusions Post-radioembolization dosimetry of lesions or other VOIs ≥ 22 mm in diameter can be consistently obtained (< 25% variability) at a multi-institutional level using PET/MRI for any clinically significant activity for 90Y radioembolization.
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Affiliation(s)
- Nichole M Maughan
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA
| | - Mootaz Eldib
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.,Department of Biomedical Engineering, City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - David Faul
- Siemens Healthineers, Siemens Medical Solutions USA, Inc., 40 Liberty Boulevard, Malvern, PA, 19355-9998, USA
| | - Maurizio Conti
- Molecular Imaging, Siemens Healthineers, 810 Innovation Dr, Knoxville, TN, 37932, USA
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Postboks 8905, 7491, Trondheim, Norway
| | - Karin Knešaurek
- Department of Radiology, Icahn School of Medicine at Mt. Sinai, One G. Levy Pl., Box 1141, New York, NY, 10029, USA
| | - Francesca Leek
- Agency for Science Technology and Research, National University of Singapore Clinical Imaging Research Centre, 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
| | - David Townsend
- Agency for Science Technology and Research, National University of Singapore Clinical Imaging Research Centre, 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
| | - Frank P DiFilippo
- Department of Nuclear Medicine, Cleveland Clinic, Mail Code Jb3, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Stephan G Nekolla
- Klinik und Poliklinik für Nuklearmedizin, TU München, Strasse 22, 81675, Munich, Germany
| | - Mathias Lukas
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Charitépl. 1, 10117, Berlin, Germany.,Siemens Healthcare GmbH, Berlin, Germany
| | - Michael Tapner
- Sirtex Medical Ltd, Level 33, 101 Miller St, North Sydney, NSW, 2060, Australia.,ABX-CRO Advanced Pharmaceutical Services, 1 Begonia Road, Normanhurst, NSW, 2076, Australia
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA.
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8225, St. Louis, MO, 63110, USA
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Joo I, Kim HC, Kim GM, Paeng JC. Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know. Korean J Radiol 2018. [PMID: 29520178 PMCID: PMC5840049 DOI: 10.3348/kjr.2018.19.2.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Seoul 03722, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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Benson AB, D'Angelica MI, Abbott DE, Abrams TA, Alberts SR, Saenz DA, Are C, Brown DB, Chang DT, Covey AM, Hawkins W, Iyer R, Jacob R, Karachristos A, Kelley RK, Kim R, Palta M, Park JO, Sahai V, Schefter T, Schmidt C, Sicklick JK, Singh G, Sohal D, Stein S, Tian GG, Vauthey JN, Venook AP, Zhu AX, Hoffmann KG, Darlow S. NCCN Guidelines Insights: Hepatobiliary Cancers, Version 1.2017. J Natl Compr Canc Netw 2017; 15:563-573. [PMID: 28476736 DOI: 10.6004/jnccn.2017.0059] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The NCCN Guidelines for Hepatobiliary Cancers provide treatment recommendations for cancers of the liver, gallbladder, and bile ducts. The NCCN Hepatobiliary Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding locoregional therapy for treatment of patients with hepatocellular carcinoma.
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Affiliation(s)
- Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | - William Hawkins
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Rojymon Jacob
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | - R Kate Kelley
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Robin Kim
- Huntsman Cancer Institute at the University of Utah
| | | | - James O Park
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Carl Schmidt
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Davendra Sohal
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - G Gary Tian
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | - Alan P Venook
- UCSF Helen Diller Family Comprehensive Cancer Center
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Imaging of Hepatocellular Carcinoma Response After 90Y Radioembolization. AJR Am J Roentgenol 2017; 209:W263-W276. [DOI: 10.2214/ajr.17.17993] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Vilgrain V, Pereira H, Assenat E, Guiu B, Ilonca AD, Pageaux GP, Sibert A, Bouattour M, Lebtahi R, Allaham W, Barraud H, Laurent V, Mathias E, Bronowicki JP, Tasu JP, Perdrisot R, Silvain C, Gerolami R, Mundler O, Seitz JF, Vidal V, Aubé C, Oberti F, Couturier O, Brenot-Rossi I, Raoul JL, Sarran A, Costentin C, Itti E, Luciani A, Adam R, Lewin M, Samuel D, Ronot M, Dinut A, Castera L, Chatellier G. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol 2017; 18:1624-1636. [PMID: 29107679 DOI: 10.1016/s1470-2045(17)30683-6] [Citation(s) in RCA: 532] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/20/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sorafenib is the recommended treatment for patients with advanced hepatocellular carcinoma. We aimed to compare the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 (90Y) resin microspheres in patients with hepatocellular carcinoma. METHODS SARAH was a multicentre, open-label, randomised, controlled, investigator-initiated, phase 3 trial done at 25 centres specialising in liver diseases in France. Patients were eligible if they were aged at least 18 years with a life expectancy greater than 3 months, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, Child-Pugh liver function class A or B score of 7 or lower, and locally advanced hepatocellular carcinoma (Barcelona Clinic Liver Cancer [BCLC] stage C), or new hepatocellular carcinoma not eligible for surgical resection, liver transplantation, or thermal ablation after a previously cured hepatocellular carcinoma (cured by surgery or thermoablative therapy), or hepatocellular carcinoma with two unsuccessful rounds of transarterial chemoembolisation. Patients were randomly assigned (1:1) by a permutated block method with block sizes two and four to receive continuous oral sorafenib (400 mg twice daily) or SIRT with 90Y-loaded resin microspheres 2-5 weeks after randomisation. Patients were stratified according to randomising centre, ECOG performance status, previous transarterial chemoembolisation, and presence of macroscopic vascular invasion. The primary endpoint was overall survival. Analyses were done on the intention-to-treat population; safety was assessed in all patients who received at least one dose of sorafenib or underwent at least one of the SIRT work-up exams. This study has been completed and the final results are reported here. The trial is registered with ClinicalTrials.gov, number NCT01482442. FINDINGS Between Dec 5, 2011, and March 12, 2015, 467 patients were randomly assigned; after eight patients withdrew consent, 237 were assigned to SIRT and 222 to sorafenib. In the SIRT group, 53 (22%) of 237 patients did not receive SIRT; 26 (49%) of these 53 patients were treated with sorafenib. Median follow-up was 27·9 months (IQR 21·9-33·6) in the SIRT group and 28·1 months (20·0-35·3) in the sorafenib group. Median overall survival was 8·0 months (95% CI 6·7-9·9) in the SIRT group versus 9·9 months (8·7-11·4) in the sorafenib group (hazard ratio 1·15 [95% CI 0·94-1·41] for SIRT vs sorafenib; p=0·18). In the safety population, at least one serious adverse event was reported in 174 (77%) of 226 patients in the SIRT group and in 176 (82%) of 216 in the sorafenib group. The most frequent grade 3 or worse treatment-related adverse events were fatigue (20 [9%] vs 41 [19%]), liver dysfunction (25 [11%] vs 27 [13%]), increased laboratory liver values (20 [9%] vs 16 [7%]), haematological abnormalities (23 [10%] vs 30 [14%]), diarrhoea (three [1%] vs 30 [14%]), abdominal pain (six [3%] vs 14 [6%]), increased creatinine (four [2%] vs 12 [6%]), and hand-foot skin reaction (one [<1%] vs 12 [6%]). 19 deaths in the SIRT group and 12 in the sorafenib group were deemed to be treatment related. INTERPRETATION In patients with locally advanced or intermediate-stage hepatocellular carcinoma after unsuccessful transarterial chemoembolisation, overall survival did not significantly differ between the two groups. Quality of life and tolerance might help when choosing between the two treatments. FUNDING Sirtex Medical Inc.
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Affiliation(s)
- Valérie Vilgrain
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France.
| | - Helena Pereira
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Eric Assenat
- Centre Hospitalier Universitaire de Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Boris Guiu
- Centre Hospitalier Universitaire de Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Alina Diana Ilonca
- Centre Hospitalier Universitaire de Montpellier, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Annie Sibert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Mohamed Bouattour
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Rachida Lebtahi
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Wassim Allaham
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France
| | - Hélène Barraud
- Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Elodie Mathias
- Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Jean-Pierre Bronowicki
- Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | | | - Rémy Perdrisot
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - René Gerolami
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France; Université Aix-Marseille, Marseille, France
| | - Olivier Mundler
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France
| | - Jean-Francois Seitz
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France; Université Aix-Marseille, Marseille, France
| | - Vincent Vidal
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France
| | | | | | | | | | | | | | - Charlotte Costentin
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Emmanuel Itti
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Alain Luciani
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France; INSERM IMRB U955 Equipe 18, Créteil, France
| | - René Adam
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Maïté Lewin
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Didier Samuel
- Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Maxime Ronot
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France
| | - Aurelia Dinut
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Laurent Castera
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U1149, Centre de Recherche de l'Inflammation (CRI), Paris, France
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité de Recherche Clinique, Paris, France; INSERM, Centre d'Investigation Clinique 1418 (CIC1418), Paris, France; Université Paris-Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
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Jadvar H. The Use of Imaging in the Prediction and Assessment of Cancer Treatment Toxicity. Diagnostics (Basel) 2017; 7:diagnostics7030043. [PMID: 28726731 PMCID: PMC5617943 DOI: 10.3390/diagnostics7030043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 01/15/2023] Open
Abstract
Multimodal imaging is commonly used in the management of patients with cancer. Imaging plays pivotal roles in the diagnosis, initial staging, treatment response assessment, restaging after treatment and the prognosis of many cancers. Indeed, it is difficult to imagine modern precision cancer care without the use of multimodal molecular imaging, which is advancing at a rapid pace with innovative developments in imaging sciences and an improved understanding of the complex biology of cancer. Cancer therapy often leads to undesirable toxicity, which can range from an asymptomatic subclinical state to severe end organ damage and even death. Imaging is helpful in the portrayal of the unwanted effects of cancer therapy and may assist with optimal clinical decision-making, clinical management, and overall improvements in the outcomes and quality of life for patients.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
OBJECTIVE This article reviews recent developments in targeted radionuclide therapy (TRT) approaches directed to malignant liver lesions, bone metastases, neuroendocrine tumors, and castrate-resistant metastatic prostate cancer and discusses challenges and opportunities in this field. CONCLUSION TRT has been employed since the first radioiodine thyroid treatment almost 75 years ago. Progress in the understanding of the complex underlying biology of cancer and advances in radiochemistry science, multimodal imaging techniques including the concept of "see and treat" within the framework of theranostics, and universal traction with the notion of precision medicine have all contributed to a resurgence of TRT.
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Soydal C, Kucuk NO, Balci D, Gecim E, Bilgic S, Elhan AH. Prognostic Importance of the Presence of Early Metabolic Response and Absence of Extrahepatic Metastasis After Selective Internal Radiation Therapy in Colorectal Cancer Liver Metastasis. Cancer Biother Radiopharm 2017; 31:342-346. [PMID: 27831761 DOI: 10.1089/cbr.2016.2105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIMS In this study, the authors aimed to identify prognostic factors after selective internal radiation therapy (SIRT) for colorectal cancer (CRC) liver metastasis. METHODS Forty-nine (28 male, 21 female; mean age: 64.6 ± 10.8) patients who received SIRT for CRC liver metastasis were studied. Effects of number (<5 vs. ≥5), maximum dimension, and standardized uptake value (SUV) of liver metastases, liver tumor load (<25% vs. 26%-50% vs. 51%-75%), presence of extrahepatic disease, and metabolic early response on overall survival were analyzed. RESULTS Mean follow-up time was 44.1 ± 27.5 months. Overall survival time was calculated as 10.03 ± 1.61 (95% CI; 6.86-13.20) months. SUV (0.004) of liver metastases, early metabolic response (p = 0.015), and presence of extrahepatic metastasis (p = 0.001) were identified as significant factors influencing overall survival. The hazard ratio was 1:2.3 for the presence of extrahepatic metastasis and 1:2.7 for the absence of early metabolic response. CONCLUSION These findings suggest that patients with CRC liver metastasis who have lower SUV at presentation and early metabolic response have better outcomes after SIRT.
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Affiliation(s)
- Cigdem Soydal
- 1 Department of Nuclear Medicine, Ankara University Medical School , Ankara, Turkey
| | - Nuriye Ozlem Kucuk
- 1 Department of Nuclear Medicine, Ankara University Medical School , Ankara, Turkey
| | - Deniz Balci
- 2 Department of Surgery, Ankara University Medical School , Ankara, Turkey
| | - Ethem Gecim
- 2 Department of Surgery, Ankara University Medical School , Ankara, Turkey
| | - Sadik Bilgic
- 3 Department of Radiology, Ankara University Medical School , Ankara, Turkey
| | - Atilla Halil Elhan
- 4 Department of Biostatistics, Ankara University Medical School , Ankara, Turkey
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Altenbernd J, Wetter A, Forsting M, Umutlu L. Treatment response after radioembolisation in patients with hepatocellular carcinoma-An evaluation with dual energy computed-tomography. Eur J Radiol Open 2016; 3:230-5. [PMID: 27622200 PMCID: PMC5009187 DOI: 10.1016/j.ejro.2016.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The aim of this prospective study was to examine the diagnostic value of dual-energy CT (DECT) in the assessment of response of HCC after radioembolisation (RE). MATERIAL AND METHODS 40 HCC patients with 82 measurable target lesions were included in this study. At baseline and follow-up examination target lesions were evaluated with (IU), AASLD and Choi measurement criteria. Disease control was defined as the sum of complete response (CR), partial response (PR), progression disease (PD) and stable disease (SD). RESULTS With Choi and IU more patients were considered than PR and less than PD and SD. According to AASLD more patients were measured as SD and PD than PR. 26/40 patients were classified as PR with IU. In contrast measurements with AASLD in only 8/26 patients were also classified as PR. 6/12 SD patients measured with IU were measured as PD with AASLD. 4/26 patients classified with IU as PR were described as SD with CHOI, 10/14 SD patients measured with CHOI were SD according to IU, the other 4 patients were PR with IU. 2/4 PD patients according to CHOI were SD with IU. CONCLUSION More patients by IU were classified as SD versus PD and PR versus SD. We attribute this to the more detailed consideration of the HU differences between the virtual native and contrast-enhanced series generated by DECT. Iodine uptake (IU) in HCC measured and visualized with DECT is a promising imaging method for the assessment of treatment response after radioembolisations. KEY POINTS -dual energy CT of hypervascular tumors such as HCC allows to quantify contrast enhancement without native imaging. -this can be used to evaluate the therapy response after Radioembolization.
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Affiliation(s)
- Jens Altenbernd
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
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Sacco R, Conte C, Tumino E, Parisi G, Marceglia S, Metrangolo S, Eggenhoffner R, Bresci G, Cabibbo G, Giacomelli L. Transarterial radioembolization for hepatocellular carcinoma: a review. J Hepatocell Carcinoma 2016; 3:25-9. [PMID: 27574589 PMCID: PMC4994804 DOI: 10.2147/jhc.s50359] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and is the second cause of death due to malignancy in the world. The treatment of HCC is complex and includes potentially curative and palliative approaches. However, both curative and palliative treatments for HCC are often associated with a not-completely favorable safety/efficacy ratio. Therefore, other treatment options appear necessary in clinical practice. Transarterial radioembolization has shown a promising efficacy in terms of disease control and is associated with a good safety profile. This review discusses the use of transarterial radioembolization in HCC, with a focus on the clinical aspects of this therapeutic strategy.
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Affiliation(s)
- Rodolfo Sacco
- Department of Gastroenterology, Cisanello Hospital, Pisa
| | - Caterina Conte
- Endocrinology and Metabolic Diseases, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome
| | | | | | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste
| | | | - Roberto Eggenhoffner
- Department of Surgical Sciences and Integrated Diagnostics, School of Medicine, Genova University, Genoa
| | | | - Giuseppe Cabibbo
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, School of Medicine, Genova University, Genoa
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Abstract
PURPOSE To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. METHODS A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. RESULTS Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. CONCLUSIONS Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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Kennedy AS, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Putnam SG, Rose SC, Savin MA, Schirm S, Sharma NK, Wang EA. Hepatic imaging response to radioembolization with yttrium-90-labeled resin microspheres for tumor progression during systemic chemotherapy in patients with colorectal liver metastases. J Gastrointest Oncol 2015; 6:594-604. [PMID: 26697190 DOI: 10.3978/j.issn.2078-6891.2015.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To assess response and the impact of imaging artifacts following radioembolization with yttrium-90-labeled resin microspheres ((90)Y-RE) based on the findings from a central independent review of patients with liver-dominant metastatic colorectal cancer (mCRC). METHODS Patients with mCRC who received (90)Y-RE (SIR-Spheres(®); Sirtex Medical, Sydney, Australia) at nine US institutions between July 2002 and December 2011 were included in the analysis. Tumor response was assessed at baseline and 3 months using either the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0 or 1.1. For each lesion, known artifacts affecting the interpretation of response (peri-tumoral edema and necrosis) were documented. Survivals (Kaplan-Meier analyses) were compared in responders [partial response (PR)] and non-responders [stable (SD) or progressive disease (PD)]. RESULTS Overall, 195 patients (mean age 62 years) received (90)Y-RE after a median of 2 (range, 1-6) lines of prior chemotherapy. Using RECIST 1.0 and RECIST 1.1, 7.6% and 6.9% of patients were partial responders, 47.3% and 48.1% had SD, and 55.0% and 55.0% PD, respectively. RECIST 1.0 and RECIST 1.1 showed excellent agreement {Kappa =0.915 [95% confidence interval (CI): 0.856-0.975]}. Peri-tumoral edema was documented in 32.8%, necrosis in 48.1% and both in 57.3% of cases (using RECIST 1.0). Although baseline characteristics were similar in responders and non-responders (P>0.05), responders survived significantly longer in an analysis according to RECIST 1.0: PR median (95% CI) 25.2 (range, 9.2-49.4) months vs. SD 15.8 (range, 9.3-21.1) months vs. PD 7.1 (range, 6.0-9.5) months (P<0.0001). CONCLUSIONS RECIST 1.0 and RECIST 1.1 imaging responses provide equivalent interpretations in the assessment of hepatic tumors following (90)Y-RE. Radiologic lesion responses at 3 months must be interpreted with caution due to the significant proportion of patients with peri-tumoral edema and necrosis, which may lead to an under-estimation of PR/SD. Nevertheless, 3-month radiologic responses were predictive of prolonged survival.
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Affiliation(s)
- Andrew S Kennedy
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - David S Ball
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven J Cohen
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael Cohn
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Douglas M Coldwell
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Alain Drooz
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eduardo Ehrenwald
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samir Kanani
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Charles W Nutting
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Fred M Moeslein
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Samuel G Putnam
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Steven C Rose
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Michael A Savin
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Sabine Schirm
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Navesh K Sharma
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
| | - Eric A Wang
- 1 Cancer Centers of North Carolina, Cary, NC, USA ; 2 Sarah Cannon Research Institute, Nashville, TN, USA ; 3 Fox Chase Cancer Center, Philadelphia, PA, USA ; 4 Radiology Associates of Hollywood, Pembroke Pines, FL, USA ; 5 James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA ; 6 Fairfax Radiological Consultants, Fairfax, VA, USA ; 7 Abbot Northwestern Hospital, Minneapolis, MN, USA ; 8 Inova Fairfax Hospital, Annandale, VA, USA ; 9 Radiology Imaging Associates, Englewood, CO, USA ; 10 University of Maryland Medical Center, Baltimore, MD, USA ; 11 University of California, San Diego Health Sciences, San Diego, CA, USA ; 12 Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA ; 13 University of Maryland School of Medicine, Baltimore, MD, USA ; 14 Charlotte Radiology, Charlotte, NC, USA
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CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review. Gastroenterol Res Pract 2015; 2015:670965. [PMID: 26798332 PMCID: PMC4700180 DOI: 10.1155/2015/670965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, affecting more than 600,000 new patients per year. Curative treatments are available in a small percentage of patients, while most of them present in stages requiring locoregional treatments such as thermoablation, transarterial chemoembolization, and/or radioembolization. These therapies
result in specific imaging features that the general radiologist has to be aware of in order to assess the response to treatment and to correctly manage the follow-up of treated patients. Multiphasic helical computed tomography has become a popular imaging modality for detecting hypervascular tumors and characterizing liver lesions. On this basis, many staging and diagnostic systems have been proposed for evaluating response to all different existing strategies. Radiofrequencies and microwaves generate thermoablation of tumors, and transarterial chemoembolization exploits the double effect of the locoregional administration of drugs and embolizing particles. Eventually radioembolization uses a beta-emitting isotope to induce necrosis. Therefore, the aim of this comprehensive review is to analyze and compare CT imaging appearance of HCC after various locoregional treatments, with regard to specific indications for all possible procedures.
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Bhangoo MS, Karnani DR, Hein PN, Giap H, Knowles H, Issa C, Steuterman S, Pockros P, Frenette C. Radioembolization with Yttrium-90 microspheres for patients with unresectable hepatocellular carcinoma. J Gastrointest Oncol 2015; 6:469-78. [PMID: 26487939 DOI: 10.3978/j.issn.2078-6891.2015.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is aggressive primary malignancy of the liver that most commonly presents late in the disease course. As a result, the majority of patients are not candidates for curative therapies. Locoregional therapies including Yttrium-90 (Y-90) radioembolization play an important role in management of the vast majority of patients with HCC. METHODS Patients with unnresectable HCC (n=17) treated with Y-90 radioembolization from 2005 to 2014 were evaluated retrospectively. Data was abstracted from medical records including patient charts, laboratory data, and imaging. Toxicities were recorded using Common Terminology Criteria 3.0. Response was recorded according to modified RECIST (mRECIST) criteria. RESULTS Seventeen patients received 33 treatments with Y-90 radioembolization. A majority (65%) received TheraSphere with a minority (35%) receiving SIR-Spheres. The median treatment activity delivered was 1.725 gBq (range, 1.4-2.5 gBq). The median treatment dose delivered was 100 Gy (range, 90-120 Gy). The median lung shunt fraction was 2.02% (range, 1.5-4.1%). The most common clinical toxicity among all patients was nausea and vomiting (59%), primarily grade 1 and 2. Other post-treatment findings included abdominal pain (29%), fatigue (53%), and weight loss (18%). One patient developed a grade 5 gastric ulcer after the treatment. A clinical benefit, defined as patients achieving complete response (CR), partial response (PR) or stable disease (SD), was seen in 48% of patients. PR was seen in 24% of cases; progressive disease (PD) was noted in 35%. Patients survived for a median of 8.4 months (range, 1.3 to 21.1 months) after the first radioembolization treatment. Median survival after Y-90 treatment was 8.4 months among patients treated TheraSphere as compared with 7.8 months in patients treated with SIR-Spheres. The mean overall survival from the time of diagnosis was 11.7 months (range, 3.4 to 43.2 months). CONCLUSIONS For patients with unresectable HCC, Y-90 radioembolization is a safe and well-tolerated procedure. Our experience suggests that a significant percentage of patients achieve clinical benefit including many with PR. Survival after treatment from this single-center, transplant center is in line with prior reports. Prospective, randomized data is required to compare radioembolization with other therapies including chemoembolization and systemic therapy with sorafenib.
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Affiliation(s)
- Munveer Singh Bhangoo
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Diraj R Karnani
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Paul N Hein
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Huan Giap
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Harry Knowles
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Chris Issa
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Steve Steuterman
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Paul Pockros
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
| | - Catherine Frenette
- 1 Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA, USA ; 2 New York University, School of Medicine, New York, NY, USA ; 3 Scripps Proton Center, San Diego, CA, USA ; 4 Department of Radiology, Scripps Green Hospital, La Jolla, CA, USA ; 5 Radiation Safety, Scripps Clinic, La Jolla, CA, USA ; 6 Center for Organ Transplantation, Scripps Green Hospital, La Jolla, CA, USA
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Seyal AR, Gonzalez-Guindalini FD, Arslanoglu A, Harmath CB, Lewandowski RJ, Salem R, Yaghmai V. Reproducibility of mRECIST in assessing response to transarterial radioembolization therapy in hepatocellular carcinoma. Hepatology 2015; 62:1111-21. [PMID: 25999236 DOI: 10.1002/hep.27915] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 05/20/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED The purpose of our study was to evaluate the reproducibility of Modified Response Evaluation Criteria in Solid Tumors (mRECIST) in hepatocellular carcinoma (HCC) lesions undergoing transarterial radioembolization (TARE) therapy and to determine whether mRECIST reproducibility is affected by the enhancement pattern of HCC. One hundred and three HCC lesions from 103 patients treated with TARE were evaluated. The single longest diameter of viable tumor tissue was measured by two radiologists at baseline; response to therapy was evaluated according to mRECIST. The enhancement pattern of HCC lesions was correlated with their mRECIST response. The response rate between mRECIST and RECIST 1.1 was compared. Wilcoxon signed-rank test, paired t test, Lin's concordance correlation coefficient (ρc ), Bland-Altman plot, kappa statistics, and Fisher's exact test were used to assess intra- and interobserver reproducibilities and to compare response rates. There were better intra- than interobserver agreements in the measurement of single longest diameter of viable tumor tissue (bias = 0 cm intraobserver versus bias = 0.3 cm interobserver). For mRECIST, good intraobserver (ĸ = 0.70) and moderate interobserver (ĸ = 0.56) agreements were noted. The mRECIST response for HCC lesions with homogeneous enhancement at both baseline and follow-up imaging showed better intra- and interobserver agreements (ĸ = 0.77 and 0.60, respectively) than lesions with heterogeneous enhancement at both scans (ĸ = 0.54 and 0.40, respectively). In the early follow-up period mRECIST showed a significantly higher response rate than RECIST (40.8% versus 3.9%; P = 0.025). CONCLUSIONS In HCC patients treated with TARE, mRECIST captures a significantly higher response rate compared with RECIST; it also demonstrates acceptable intra- and interobserver reproducibilities for HCC lesions treated with TARE, and mRECIST reproducibility may be lower for HCC lesions with heterogeneous distribution of the viable tumor tissue.
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Affiliation(s)
- Adeel R Seyal
- Department of Radiology, Northwestern University, Chicago, IL
| | | | | | - Carla B Harmath
- Department of Radiology, Northwestern University, Chicago, IL
| | | | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, IL.,Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University, Chicago, IL
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Sacco R, Giorgi L, Fornaro L, Bargellini I. Trans-Arterial Radioembolization for Hepatocellular Carcinoma. Dig Dis 2015; 33:661-7. [PMID: 26398498 DOI: 10.1159/000438476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article offers an overview of a new therapeutic option in hepatocellular carcinoma using trans-arterial radioembolization. In particular, it covers practical aspects of the technique and the currently available preliminary data in terms of disease control. We explore the potentials of radioembolization both in early and advanced stages of the disease, as single treatment and as companion to targeted agents such as sorafenib.
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Affiliation(s)
- Rodolfo Sacco
- Department of Gastroenterology, Pisa University Hospital, Pisa, Italy
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Imaging of the Liver Following Interventional Therapy for Hepatic Neoplasms. Radiol Clin North Am 2015; 53:1061-76. [DOI: 10.1016/j.rcl.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Schelhorn J, Best J, Reinboldt MP, Gerken G, Ruhlmann M, Lauenstein TC, Antoch G, Kinner S. Therapy Response Assessment after Radioembolization of Patients with Hepatocellular Carcinoma—Comparison of MR Imaging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid and Gadobutrol. J Vasc Interv Radiol 2015; 26:972-9. [DOI: 10.1016/j.jvir.2015.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/26/2015] [Accepted: 03/14/2015] [Indexed: 11/26/2022] Open
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Sofocleous CT, Violari EG, Sotirchos VS, Shady W, Gonen M, Pandit-Taskar N, Petre EN, Brody LA, Alago W, Do RK, D'Angelica MI, Osborne JR, Segal NH, Carrasquillo JA, Kemeny NE. Radioembolization as a Salvage Therapy for Heavily Pretreated Patients With Colorectal Cancer Liver Metastases: Factors That Affect Outcomes. Clin Colorectal Cancer 2015; 14:296-305. [PMID: 26277696 DOI: 10.1016/j.clcc.2015.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND In this study we assessed the efficacy and factors that affect outcomes of radioembolization (RE) using yttrium-90 resin microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastases (CLM). PATIENTS AND METHODS After an institutional review board waiver of approval, a review of a Health Insurance Portability and Accountability Act-registered, prospectively created and maintained database was performed. Data on patient demographic and disease characteristics, RE treatment parameters, and additional treatments were evaluated for significance in predicting overall survival (OS) and liver progression-free survival (LPFS). Complications were evaluated according to the National Cancer Institute Common Terminology Criteria for adverse events. RESULTS From September 2009 to September 2013, 53 patients underwent RE at a median of 35 months after CLM diagnosis. Median OS was 12.7 months. Multivariate analysis showed that carcinoembryonic antigen levels at the time of RE ≥ 90 ng/mL (P = .004) and microscopic lymphovascular invasion of the primary (P = .002) were independent predictors of decreased OS. Median LPFS was 4.7 months. At 4 to 8 and 12 to 16 weeks after RE, most patients (80% and 61%, respectively) according to Response Evaluation Criteria in Solid Tumors (RECIST) had stable disease; additional evaluation using PET Response Criteria in Solid Tumors (PERCIST) led to reclassification in 77% of these cases (response or progression). No deaths were noted within the first 30 days. Within the first 90 days after RE, 4 patients (8%) developed liver failure and 5 patients (9%) died, all with evidence of disease progression. CONCLUSION RE in the salvage setting was well-tolerated, and permitted the administration of additional therapies and led to a median OS of 12.7 months. Evaluation using PERCIST was more likely than RECIST to document response or progression compared with the baseline assessment before RE.
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Affiliation(s)
| | - Elena G Violari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Waleed Shady
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Joseph R Osborne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Sacco R, Mismas V, Marceglia S, Romano A, Giacomelli L, Bertini M, Federici G, Metrangolo S, Parisi G, Tumino E, Bresci G, Corti A, Tredici M, Piccinno M, Giorgi L, Bartolozzi C, Bargellini I. Transarterial radioembolization for hepatocellular carcinoma: An update and perspectives. World J Gastroenterol 2015; 21:6518-25. [PMID: 26074690 PMCID: PMC4458762 DOI: 10.3748/wjg.v21.i21.6518] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/13/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023] Open
Abstract
In the last decade trans-arterial radioembolization has given promising results in the treatment of patients with intermediate or advanced stage hepatocellular carcinoma (HCC), both in terms of disease control and tolerability profile. This technique consists of the selective intra-arterial administration of microspheres loaded with a radioactive compound (usually Yttrium(90)), and exerts its therapeutic effect through the radiation carried by these microspheres. A careful and meticulous selection of patients is crucial before performing the radioembolization to correctly perform the procedure and reduce the incidence of complications. Radioembolization is a technically complex and expensive technique, which has only recently entered clinical practice and is supported by scant results from phase III clinical trials. Nevertheless, it may represent a valid alternative to transarterial chemoembolization (TACE) in the treatment of intermediate-stage HCC patients, as shown by a comparative retrospective assessment that reported a longer time to progression, but not of overall survival, and a more favorable safety profile for radioembolization. In addition, this treatment has reported a higher percentage of tumor shrinkage, if compared to TACE, for pre-transplant downsizing and it represents a promising therapeutic option in patients with large extent of disease and insufficient residual liver volume who are not immediately eligible for surgery. Radioembolization might also be a suitable companion to sorafenib in advanced HCC or it can be used as a potential alternative to this treatment in patients who are not responding or do not tolerate sorafenib.
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Franklin JM, Gebski V, Poston GJ, Sharma RA. Clinical trials of interventional oncology—moving from efficacy to outcomes. Nat Rev Clin Oncol 2014; 12:93-104. [DOI: 10.1038/nrclinonc.2014.199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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50
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Vouche M, Salem R, Lewandowski RJ, Miller FH. Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC? ACTA ACUST UNITED AC 2014; 40:1471-80. [DOI: 10.1007/s00261-014-0295-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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