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Bothara SS, Parihar P, Patil R. Advancements in Interventional Radiology for Managing Hepatic Encephalopathy: A Comprehensive Review. Cureus 2024; 16:e62723. [PMID: 39036219 PMCID: PMC11259514 DOI: 10.7759/cureus.62723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome resulting from liver dysfunction, leading to cognitive, behavioral, and motor impairments. The management of HE has traditionally relied on pharmacological treatments, dietary modifications, and liver transplantation. However, recent advancements in interventional radiology (IR) have introduced minimally invasive procedures that offer promising alternatives. This comprehensive review explores the latest IR techniques, including transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), portal vein embolization (PVE), and Yttrium-90 (Y90) radioembolization. The efficacy, clinical outcomes, and potential complications of these techniques are examined through an analysis of current studies and trials. The review highlights the benefits of IR in reducing portal hypertension and improving hepatic blood flow, ultimately alleviating HE symptoms. Additionally, it underscores the importance of multidisciplinary collaboration, ongoing research, and the development of clear patient selection criteria to optimize the use of IR in HE management. By integrating these advancements into clinical practice, healthcare providers can enhance the quality of care and improve outcomes for patients with HE.
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Affiliation(s)
- Shivani S Bothara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ravishankar Patil
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Andersen IV, Bidesi NSR, Shalgunov V, Jørgensen JT, Gustavsson T, Strømgaard K, Ingemann Jensen AT, Kjær A, Herth MM. Investigation of imaging the somatostatin receptor by opening the blood-brain barrier with melittin - A feasibility study using positron emission tomography and [ 64Cu]Cu-DOTATATE. Nucl Med Biol 2024; 132-133:108905. [PMID: 38555651 DOI: 10.1016/j.nucmedbio.2024.108905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/28/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024]
Abstract
DOTATATE is a somatostatin peptide analog used in the clinic to detect somatostatin receptors which are highly expressed on neuroendocrine tumors. Somatostatin receptors are found naturally in the intestines, pancreas, lungs, and brain (mainly cortex). In vivo measurement of the somatostatin receptors in the cortex has been challenging because available tracers cannot cross the blood-brain barrier (BBB) due to their intrinsic polarity. A peptide called melittin, a main component of honeybee venom, has been shown to disrupt plasma membranes and increase the permeability of biological membranes. In this study, we assessed the feasibility of using melittin to facilitate the passage of [64Cu]Cu-DOTATATE through the BBB and its binding to somatostatin receptors in the cortex. Evaluation included in vitro autoradiography on Long Evans rat brains to estimate the binding affinity of [64Cu]Cu-DOTATATE to the somatostatin receptors in the cortex and an in vivo evaluation of [64Cu]Cu-DOTATATE binding in NMRI mice after injection of melittin. This study found an in vitro Bmax = 89 ± 4 nM and KD = 4.5 ± 0.6 nM in the cortex, resulting in a theoretical binding potential (BP) calculated as Bmax/KD ≈ 20, which is believed suitable for in vivo brain PET imaging. However, the in vivo results showed no significant difference between the control and melittin injected mice, indicating that the honeybee venom failed to open the BBB. Additional experiments, potentially involving faster injection rates are required to verify that melittin can increase brain uptake of non-BBB permeable PET tracers. Furthermore, an evaluation of whether a venom with a narrow therapeutic range can be used for clinical purposes needs to be considered.
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Affiliation(s)
- Ida Vang Andersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark
| | - Natasha Shalina Rajani Bidesi
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Tranekjær Jørgensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tobias Gustavsson
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark
| | - Kristian Strømgaard
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark
| | - Andreas T Ingemann Jensen
- Center for Nanomedicine and Theranostics, DTU Health Technology Technical University of Denmark (DTU) Ørsteds Plads 345C, 2800 Lyngby, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Matthias M Herth
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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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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Budzyńska A, Kubik A, Kacperski K, Pastusiak P, Kuć M, Piasecki P, Konior M, Gryziński M, Dziuk M, Iller E. PET/CT and SPECT/CT imaging of 90Y hepatic radioembolization at therapeutic and diagnostic activity levels: Anthropomorphic phantom study. PLoS One 2024; 19:e0271711. [PMID: 38421965 PMCID: PMC10903856 DOI: 10.1371/journal.pone.0271711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Prior to 90Y radioembolization procedure, a pretherapy simulation using 99mTc-MAA is performed. Alternatively, a small dosage of 90Y microspheres could be used. We aimed to assess the accuracy of lung shunt fraction (LSF) estimation in both high activity 90Y posttreatment and pretreatment scans with isotope activity of ~100 MBq, using different imaging techniques. Additionally, we assessed the feasibility of visualising hot and cold hepatic tumours in PET/CT and Bremsstrahlung SPECT/CT images. MATERIALS AND METHODS Anthropomorphic phantom including liver (with two spherical tumours) and lung inserts was filled with 90Y chloride to simulate an LSF of 9.8%. The total initial activity in the liver was 1451 MBq, including 19.4 MBq in the hot sphere. Nine measurement sessions including PET/CT, SPECT/CT, and planar images were acquired at activities in the whole phantom ranging from 1618 MBq down to 43 MBq. The visibility of the tumours was appraised based on independent observers' scores. Quantitatively, contrast-to-noise ratio (CNR) was calculated for both spheres in all images. RESULTS LSF estimation. For high activity in the phantom, PET reconstructions slightly underestimated the LSF; absolute difference was <1.5pp (percent point). For activity <100 MBq, the LSF was overestimated. Both SPECT and planar scintigraphy overestimated the LSF for all activities. Lesion visibility. For SPECT/CT, the cold tumour proved too small to be discernible (CNR <0.5) regardless of the 90Y activity in the liver, while hot sphere was visible for activity >200 MBq (CNR>4). For PET/CT, the cold tumour was only visible with the highest 90Y activity (CNR>4), whereas the hot one was seen for activity >100 MBq (CNR>5). CONCLUSIONS PET/CT may accurately estimate the LSF in a 90Y posttreatment procedure. However, at low activities of about 100 MBq it seems to provide unreliable estimations. PET imaging provided better visualisation of both hot and cold tumours.
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Affiliation(s)
- Anna Budzyńska
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Agata Kubik
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Krzysztof Kacperski
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- National Centre for Nuclear Research, Particle Acceleration Physics and Technology Division (TJ1), Otwock—Świerk, Poland
| | - Patrycja Pastusiak
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Michał Kuć
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Marcin Konior
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
| | - Michał Gryziński
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Edward Iller
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
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Villalobos A, Pisanie JLD, Gandhi RT, Kokabi N. Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips. Semin Intervent Radiol 2024; 41:63-78. [PMID: 38495257 PMCID: PMC10940044 DOI: 10.1055/s-0044-1779715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Alexander Villalobos
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Johannes L. du Pisanie
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ripal T. Gandhi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nima Kokabi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sag AA, Agritelley E, Ronald J, Young SJ, Kim CY. Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol. Nucl Med Commun 2024; 45:61-67. [PMID: 37901924 DOI: 10.1097/mnm.0000000000001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total). METHODS IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records. RESULTS Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity <10 mCi, treatment of smaller liver volumes (<200 ml) and documentation of stasis were associated with higher residual activity ( P = 0.025, P = 0.0007, P = 0.0177, and P = 0.049, respectively) were associated with higher residuals. CONCLUSION Combining the new technologies of SIROS and the Truselect microcatheter with a double-flush protocol yielded <10% residual in 94% of y90 infusions. Future studies may clarify if the predictors of high residual dose seen here may warrant microcatheter-specific considerations for dosimetry or dose preparation at the Radiopharmacy level.
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Affiliation(s)
- Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
| | | | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
| | - Shamar J Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona Medical Center, Tucson, Arizona, USA
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
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Gorji L, Aoun H, Critchfield J, Al Hallak N, Beal EW. Locoregional Therapy for Intrahepatic Cholangiocarcinoma: The Role of Intra-Arterial Therapies. Cancers (Basel) 2023; 15:4727. [PMID: 37835420 PMCID: PMC10571998 DOI: 10.3390/cancers15194727] [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: 09/03/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare disease with a rising incidence. While surgical resection is the only curative option, the disease process is often identified in advanced stages, as this malignancy often remains clinically silent in early development. Only one-third of patients are eligible for resection at the time of diagnosis. For patients who cannot undergo resection, intra-arterial therapies are reasonable palliative treatment options; in rare occasions, these may be bridging therapies, as well. The premise of bland embolization and most chemoembolization intra-arterial therapies is that the arterial supply of the tumor is occluded to induce tumor necrosis, while radioembolization utilizes the arterial flow of the tumor to deliver radiation therapy. In this review, we discuss the use of transarterial embolization, transarterial chemoembolization, and selective internal radiation therapy for the treatment of ICC. Phase III randomized controlled clinical trials are difficult to tailor to this extremely rare and aggressive disease, but ultimately, further investigation should be pursued to define the patient population that will derive the greatest benefit from each modality.
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Affiliation(s)
- Leva Gorji
- Department of Surgery, Kettering Health, Dayton, OH 45402, USA;
| | - Hussein Aoun
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Jeffrey Critchfield
- Department of Interventional Radiology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
| | - Eliza W. Beal
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA;
- Department of Surgery, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
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Birajdar S, Zhang W, Santos A, Hickson K, Afshar Vahid S. Real-time in vivo dose measurement using ruby-based fibre optic dosimetry during internal radiation therapy. Phys Eng Sci Med 2023; 46:1205-1213. [PMID: 37395926 PMCID: PMC10480264 DOI: 10.1007/s13246-023-01288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
In vivo dosimetry (IVD) in a commonly used liver cancer treatment of selective internal radiation therapy (SIRT) has been done based on the post-treatment image-based dosimetry approach. Real-time IVD is necessary to verify the dose delivery and detect errors during the treatment for better patient outcomes. This study aims to develop a fibre optic dosimeter (FOD) for in vivo real-time dose rate measurement during internal beta radiation therapy, e.g., SIRT. A ruby fibre optic probe was prepared and studied the radioluminescence (RL) characteristics, including its major challenge of stem effect arising from Cherenkov radiation and luminescence from the irradiated fibre. The stem signal was suppressed adequately using the stem removal technique of optical filtering, and only 2.3 ± 1.1% stem signal was contributed to the measured RL signal. A linear dose rate response was observed during the exposure of the ruby probe to varying dose rates using a 6 MeV electron beam and a positron-emitting radionuclide fluorine-18. The ruby exhibited a temporally non-constant RL signal, which increased the RL signal by 0.84 ± 0.29 counts/sec2 during the irradiation of the maximum dose rate used in this study of 9 Gy/min for 2 min. The ability of ruby FOD to measure the absolute dose rate with sufficient stem effect suppression and the linear RL dose rate response indicates its suitability for real-time IVD during internal beta radiation therapy. Future work will investigate the time-dependent RL characteristic of ruby and validate post-treatment image-based dosimetry using ruby-based FOD.
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Affiliation(s)
- S Birajdar
- Laser Physics and Photonic Devices Laboratories, UNISA STEM, The University of South Australia, Adelaide, SA, 5095, Australia.
| | - W Zhang
- Laser Physics and Photonic Devices Laboratories, UNISA STEM, The University of South Australia, Adelaide, SA, 5095, Australia
| | - A Santos
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- School of Physical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA, 5000, Australia
| | - K Hickson
- Medical Physics & Radiation Protection Group, SA Medical Imaging, Adelaide, SA, 5000, Australia
- Allied Health & Human Performance, University of South Australia, Adelaide, SA, 5001, Australia
| | - S Afshar Vahid
- Laser Physics and Photonic Devices Laboratories, UNISA STEM, The University of South Australia, Adelaide, SA, 5095, Australia
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Domouchtsidou A, Beckmann F, Marenbach B, Mueller SP, Best J, Herrmann K, Horn PA, Barsegian V, Lindemann M. In Patients Treated by Selective Internal Radiotherapy, Cellular In Vitro Immune Function Is Predictive of Survival. Cancers (Basel) 2023; 15:4055. [PMID: 37627082 PMCID: PMC10452121 DOI: 10.3390/cancers15164055] [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: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
In patients with liver malignancies, the cellular immune function was impaired in vitro after selective internal radiotherapy (SIRT). Because immunosuppression varied substantially, in the current study, we investigated in 25 SIRT patients followed up for ten years whether the lymphocyte function was correlated with survival. Peripheral blood mononuclear cells were stimulated with four microbial antigens (tuberculin, tetanus toxoid, Candida albicans and CMV) before therapy and at four time points thereafter, and lymphocyte proliferation was determined by H3-thymidine uptake. The median sum of the responses to these four antigens decreased from 39,464 counts per minute (CPM) increment (range 1080-204,512) before therapy to a minimum of 700 CPM increment on day 7 after therapy (0-93,187, p < 0.0001). At all five time points, the median survival in patients with weaker responses was 2- to 3.5-fold shorter (p < 0.05). On day 7, the median survival in patients with responses below and above the cutoff of a 2 CPM increment was 185 and 523 days, respectively (χ2 = 9.4, p = 0.002). In conclusion, lymphocyte function could be a new predictor of treatment outcome after SIRT.
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Affiliation(s)
- Aglaia Domouchtsidou
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 179, 45147 Essen, Germany; (A.D.); (F.B.); (B.M.); (P.A.H.)
- Department of Microbiology, General Anticancer Oncological Hospital “Agios Savvas”, 115 22 Athens, Greece
| | - Ferdinand Beckmann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 179, 45147 Essen, Germany; (A.D.); (F.B.); (B.M.); (P.A.H.)
| | - Beate Marenbach
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 179, 45147 Essen, Germany; (A.D.); (F.B.); (B.M.); (P.A.H.)
| | - Stefan P. Mueller
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (S.P.M.); (K.H.); (V.B.)
| | - Jan Best
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (S.P.M.); (K.H.); (V.B.)
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 179, 45147 Essen, Germany; (A.D.); (F.B.); (B.M.); (P.A.H.)
| | - Vahé Barsegian
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (S.P.M.); (K.H.); (V.B.)
- Institute of Nuclear Medicine, Helios Kliniken, 19049 Schwerin, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Virchowstraße 179, 45147 Essen, Germany; (A.D.); (F.B.); (B.M.); (P.A.H.)
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Blum S, Silvestrini E, Weinstein J, Greben C. Posttreatment Exposure Rates for 90Y-Microsphere Patients: A Comparison of Products. J Nucl Med Technol 2023; 51:60-62. [PMID: 36041878 DOI: 10.2967/jnmt.122.264335] [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: 05/06/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
There has been a significant increase in the use of 90Y-microspheres in treating liver malignancies. This increase could be seen over the last 30 y, and Food and Drug Administration approval of 2 products-Sirtex SIR-Spheres and Boston Scientific TheraSphere-has helped in the proliferation of these treatments. As the increase in use of both products rose at our institution, there was a need to determine whether there should be special considerations for patients who receive one product compared with patients who receive the other product. This determination was made by measuring exposure rates for several regions of the patient before and after implantation. An independent-samples t test analysis (ɑ = 0.05) was performed for 50 patients (25 TheraSphere and 25 SIR-Spheres) to determine whether the products behaved similarly to the extent that exposure to others was minimized and that as-low-as-reasonably-achievable principles were kept. The results showed that the products exhibited no significant differences in exposure rates, suggesting that no special considerations are needed for the procedure for one product compared with the other.
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Affiliation(s)
| | - Eugenio Silvestrini
- Radiation Safety, Department of Radiology, Northwell Health, Manhasset, New York; .,Department of Physics and Astronomy, Hofstra University, Hempstead, New York; and
| | - Jonathan Weinstein
- Donald and Barbara Zucker School of Medicine, Northwell Health, Hofstra University, Hempstead, New York
| | - Craig Greben
- Donald and Barbara Zucker School of Medicine, Northwell Health, Hofstra University, Hempstead, New York
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11
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Larsen LI, López GP, Selwyn R, Carroll NJ. Microfluidic Fabrication of Silica Microspheres Infused with Positron Emission Tomography Imaging Agents. ACS APPLIED BIO MATERIALS 2023; 6:712-721. [PMID: 36633291 DOI: 10.1021/acsabm.2c00940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Selective internal radiation therapy (SIRT) is a treatment which delivers radioactive therapeutic microspheres via the hepatic artery to destroy tumorigenic tissue of the liver. However, the dose required varies significantly from patient to patient due to nuances in individual biology. Therefore, a positron emission tomography (PET) imaging surrogate, or radiotracer, is used to predict in vivo behavior of therapeutic Y-90 spheres. The ideal surrogate should closely resemble Y-90 microspheres in morphology for highest predictive accuracy. This work presents the fabrication of positron-emitting silica microspheres infused with PET radiotracers copper, fluorine, and gallium. A quick one-pot synthesis is used to create precursor sol, followed by droplet formation with flow-focusing microfluidics, and finally thermal treatment to yield 10-50 μm microspheres with narrow size distribution. Loading of the infused element is controllable in the sol synthesis, while the final sphere size is tunable based on microfluidic flow rates and device channel width. The system is then employed to make radioactive Ga-68 microspheres, which are tested for radioactivity and stability. The fabrication method can be completed within a few hours, depending on the desired microsphere quantity. A microfluidic system is applied to fabricate silica particles loaded with diverse elemental infusions, including radioactive Ga-68.
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Affiliation(s)
- Lewis I Larsen
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Gabriel P López
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Reed Selwyn
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico87131, United States
| | - Nick J Carroll
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico87131, United States.,Center for Micro-Engineered Materials, University of New Mexico, Albuquerque, New Mexico87131, United States
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Puleo L, Agate L, Bargellini I, Boni G, Piaggi P, Traino C, Depalo T, Lorenzoni G, Bianchi F, Volterrani D, Brogioni S, Bottici V, Brunetto MR, Coco B, Molinaro E, Elisei R. Yttrium-90 transarterial radioembolization for liver metastases from medullary thyroid cancer. Eur Thyroid J 2022; 11:e220130. [PMID: 36126186 PMCID: PMC9641787 DOI: 10.1530/etj-22-0130] [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: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Liver metastases occur in 45% of patients with advanced metastatic medullary thyroid cancer (MTC). Transarterial radioembolization (TARE) has been proposed to treat liver metastases (LM), especially in neuroendocrine tumors. The aim of this study was to investigate the biochemical (calcitonin and carcino-embryonic antigen) and objective response of liver metastases from MTC to TARE. Methods TARE is an internal radiotherapy in which microspheres loaded with β-emitting yttrium-90 (90Y) are delivered into the hepatic arteries that supply blood to LM. Eight patients with progressive multiple LM underwent TARE and were followed prospectively. They were clinically, biochemically and radiologically evaluated at 1, 4, 12 and 18 months after TARE. Results Two patients were excluded from the analysis due to severe liver injury and death due to extrahepatic disease progression, respectively. One month after TARE, a statistically significant (P = 0.02) reduction of calcitonin was observed in all patients and remained clinically relevant during follow-up; reduction of CEA, although not significant, was found in all patients. Significant reduction of liver tumor mass was observed 1, 4 and 12 months after TARE (P = 0.007, P = 0.004, P = 0.002, respectively). After 1 month, three of six patients showed partial response (PR) and three of six stable disease (SD) according to RECIST 1.1, while five of six patients had a PR and one of six a SD according to mRECIST. The clinical response remained relevant 18 months after TARE. Excluding one patient, all others showed only a slight and transient increase in liver enzymes. Conclusions TARE is effective in LM treatment of MTC. The absence of severe complications and the good tolerability make TARE a valid therapeutic strategy when liver LM are multiple and progressive.
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Affiliation(s)
- Luciana Puleo
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | - Laura Agate
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | | | - Paolo Piaggi
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | | | | | | | | | - Sandra Brogioni
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | - Valeria Bottici
- Endocrine Unit, Department of Clinical and Experimental Medicine
| | | | - Barbara Coco
- Hepatology Unit, University of Pisa, Pisa, Italy
| | | | - Rossella Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine
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13
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Liu R, Li H, Qiu Y, Liu H, Cheng Z. Recent Advances in Hepatocellular Carcinoma Treatment with Radionuclides. Pharmaceuticals (Basel) 2022; 15:1339. [PMID: 36355512 PMCID: PMC9694760 DOI: 10.3390/ph15111339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 06/20/2024] Open
Abstract
As the third leading cause of cancer death worldwide, hepatocellular carcinoma (HCC) is characterized by late detection, difficult diagnosis and treatment, rapid progression, and poor prognosis. Current treatments for liver cancer include surgical resection, radiofrequency ablation, liver transplantation, chemotherapy, external radiation therapy, and internal radionuclide therapy. Radionuclide therapy is the use of high-energy radiation emitted by radionuclides to eradicate tumor cells, thus achieving the therapeutic effect. Recently, with the continuous development of biomedical technology, the application of radionuclides in treatment of HCC has progressed steadily. This review focuses on three types of radionuclide-based treatment regimens, including transarterial radioembolization (TARE), radioactive seed implantation, and radioimmunotherapy. Their research progress and clinical applications are summarized. The advantages, limitations, and clinical potential of radionuclide treatment of HCC are discussed.
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Affiliation(s)
- Ruiqi Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hong Li
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Yihua Qiu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Hongguang Liu
- Institute of Molecular Medicine, College of Life and Health Sciences, Northeastern University, Shenyang 110000, China
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai 264117, China
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Effect of tumour involvement on activity determination of resin Yttrium-90 in selective internal radiation therapy of metastatic liver cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction:
The study was aimed to evaluate the effect of tumour involvement on resin Yttrium-90 (Y90) activity determination for metastatic liver cancer treatment.
Methods:
One hundred and two cases of resin Y90 microsphere treatment were retrospectively studied. Body surface area (BSA) method was used in the calculation of resin Y90 activity. The total activity (TA) was calculated as a summation of activities obtained from BSA-based calculation and tumour involvement (TI). TI and TA of each case were evaluated. The contributions of TI to TA were calculated with the ratio of TI/TA.
Results:
The average contribution of TI to TA was 4·1%. The contributions were < 5·8% in 75% of the cases, < 2·2% in 50% of the cases and < 1·0% in 25% of the cases.
Conclusions:
Overall the effect of tumour involvement on the activity determination was small. The activity calculation could be simplified by neglecting TI in 25% of the cases where the activity contribution from TI was less than 1%. Contouring tumour and liver structures for TI calculation could be avoided in these cases, and the efficiency of the workflow for resin Y90 procedures could be improved.
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15
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Gupta P, Kalra N, Chaluvashetty SB, Gamangatti S, Mukund A, Abdul R, Shyam VS, Baijal SS, Mohan C. Indian College of Radiology and Imaging Guidelines on Interventions in Hepatocellular Carcinoma. Indian J Radiol Imaging 2022; 32:540-554. [DOI: 10.1055/s-0042-1754361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractHepatocellular carcinoma (HCC) is one of the most common malignancies and a significant cause of cancer-related death. Treatment of HCC depends on the stage of the tumor. As many patients with HCC are not deemed fit for surgical resection or liver transplantation, locoregional therapies play an essential role in the management. Image-guided locoregional treatments include percutaneous ablative therapies and endovascular therapies. The choice of an individual or a combination of therapies is guided by the tumor and patient characteristics. As the outcomes of image-guided locoregional treatments depend on the ability to achieve necrosis of the entire tumor along with a safety margin around it, it is mandatory to follow standard guidelines. In this manuscript, we discuss in detail the various aspects of image-guided locoregional therapies to guide interventional radiologists involved in the care of patients with HCC.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Amar Mukund
- Department of Interventional Radiology, ILBS, New Delhi, India
| | - Razik Abdul
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - VS Shyam
- Department of Interventional Radiology, ILBS, New Delhi, India
| | | | - Chander Mohan
- Department of Interventional Radiology, BLK Superspeciality Hospital, New Delhi, India
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Chin RI, Bommireddy A, Fraum TJ, Ludwig DR, Huang Y, Zoberi JE, Garcia-Ramirez JL, Maughan NM, Chapman W, Korenblat K, Henke LE, Kim H, Badiyan SN. Clinical Outcomes of Patients With Unresectable Primary Liver Cancer Treated With Yttrium-90 Radioembolization With an Escalated Dose. Adv Radiat Oncol 2022; 7:100948. [PMID: 35814852 PMCID: PMC9260102 DOI: 10.1016/j.adro.2022.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/15/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Yttrium-90 (90Y) radioembolization with an escalated dose has been shown to improve clinical outcomes compared with standard dose radioembolization, but there are few data on the local control of primary liver tumors. We reported the clinical outcomes of patients with unresectable primary liver tumors treated with 90Y radioembolization with an escalated dose. Methods and Materials Clinical data of patients with unresectable hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), and biphenotypic tumors (cHCC-CC) treated with radioembolization with an escalated dose (≥150 Gy) between 2013 and 2020 with >3 months follow-up were retrospectively reviewed. The primary endpoint was freedom from local progression. Clinical response was defined by Modified Response Evaluation Criteria in Solid Tumours and toxic effects were assessed using Common Terminology Criteria for Adverse Events version 5.0. Results Fifty-three patients with HCC and 15 patients with CC/cHCC-CC were analyzed. The median dose delivered was 205 Gy (interquartile range, 183-253 Gy) and 198 Gy (interquartile range, 154-234 Gy) for patients with HCC and CC/cHCC-CC, respectively. The 1-year freedom from local progression rate was 54% (95% confidence interval [CI], 38%-78%) for patients with HCC and 66% (95% CI, 42%-100%) for patients with CC/cHCC-CC. For patients with HCC, United Network for Organ Sharing nodal stage 1 (P = .01), nonsolitary tumors (P = .02), pretreatment α-fetoprotein of >7.7 ng/mL (P = .006), and ≤268 Gy dose delivered (P = .003) were predictors for local progression on multivariate Cox analysis. No patients with HCC who received a dose >268 Gy had a local tumor progression. The 1-year overall survival for patients with HCC was 74% (95% CI, 61%-89%). After radioembolization, 5 (7%) patients had grade 3 ascites, and 4 (6%) patients had grade 3/4 hyperbilirubinemia. Conclusions Treatment of unresectable primary liver tumors with 90Y radioembolization with an escalated dose was safe and well tolerated. Delivery of >268 Gy may improve local tumor control of HCC. Determination of the maximum tolerated dose needs to be performed in the context of future prospective dose-escalation trials to further evaluate the safety and efficacy of such an approach.
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d’Abadie P, Walrand S, Lhommel R, Hesse M, Borbath I, Jamar F. Optimization of the Clinical Effectiveness of Radioembolization in Hepatocellular Carcinoma with Dosimetry and Patient-Selection Criteria. Curr Oncol 2022; 29:2422-2434. [PMID: 35448170 PMCID: PMC9024927 DOI: 10.3390/curroncol29040196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Abstract
Selective internal radiation therapy (SIRT) is part of the treatment strategy for hepatocellular carcinoma (HCC). Strong clinical data demonstrated the effectiveness of this therapy in HCC with a significant improvement in patient outcomes. Recent studies demonstrated a strong correlation between the tumor response and the patient outcome when the tumor-absorbed dose was assessed by nuclear medicine imaging. Dosimetry plays a key role in predicting the clinical response and can be optimized using a personalized method of activity planning (multi-compartmental dosimetry). This paper reviews the main clinical results of SIRT in HCC and emphasizes the central role of dosimetry for improving it effectiveness. Moreover, some patient and tumor characteristics predict a worse outcome, and toxicity related to SIRT treatment of advanced HCC patient selection based on the performance status, liver function, tumor characteristics, and tumor targeting using technetium-99m macro-aggregated albumin scintigraphy can significantly improve the clinical performance of SIRT.
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Affiliation(s)
- Philippe d’Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (S.W.); (R.L.); (M.H.); (F.J.)
- Correspondence: ; Tel.: +32-2764-7944
| | - Stephan Walrand
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (S.W.); (R.L.); (M.H.); (F.J.)
| | - Renaud Lhommel
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (S.W.); (R.L.); (M.H.); (F.J.)
| | - Michel Hesse
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (S.W.); (R.L.); (M.H.); (F.J.)
| | - Ivan Borbath
- Department of Gastroenterology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (S.W.); (R.L.); (M.H.); (F.J.)
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Teyateeti A, Mahvash A, Long J, Abdelsalam M, Avritscher R, Kaseb A, Odisio B, Ravizzini G, Surasi D, Teyateeti A, Macapinlac H, Kappadath SC. Disease control and failure patterns of unresectable hepatocellular carcinoma following transarterial radioembolization with yttrium-90 microspheres and with/without sorafenib. World J Gastroenterol 2021; 27:8166-8181. [PMID: 35068861 PMCID: PMC8704272 DOI: 10.3748/wjg.v27.i47.8166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/28/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Impressive survival outcome of our previous study in unresectable hepatocellular carcinoma (HCC) patients undergoing yttrium-90 glass microspheres transarterial radioembolization (TARE) with/without sorafenib according to individuals' disease burden, i.e., intrahepatic tumor load (IHT) and adverse disease features (ADFs) might partly be confounded by other treatments and underlying hepatic function. Therefore, a dedicated study focusing on treatment response and assessment of failure patterns might be a way to improve treatment outcome in addition to patient selection based on the disease burden. AIM To assess the tumor response, disease control and patterns of disease progression following TARE with/without sorafenib in unresectable HCC patients. METHODS This retrospective study was conducted in successful TARE procedures with available pre- and post-treatment imaging studies (n = 169). Three treatment subgroups were (1) TARE only (TARE_alone) for IHT ≤ 50% without ADFs, i.e., macrovascular invasion, extrahepatic disease (EHD) and infiltrative/ill-defined HCC (n = 63); (2) TARE with sorafenib (TARE_sorafenib) for IHT > 50% and/or presence of ADFs (n = 81); and (3) TARE only for patients who could not receive sorafenib due to contraindication or intolerance (TARE_no_sorafenib) (n = 25). Objective response rate (ORR; consisted of complete response (CR) and partial response (PR)), disease control rate (DCR; consisted of CR, PR and stable disease) and failure patterns of treated, intrahepatic and extrahepatic sites were assessed using the modified response evaluation criteria in solid tumors. Time to progression (TTP) was calculated from TARE to the first radiologic progression at any site using Kaplan-Meier method. Identification of prognostic factors for TTP using the univariate Kaplan-Meier method and multivariate Cox proportional hazard model were performed in major population subgroups, TARE_alone and TARE_sorafenib. RESULTS The median radiologic follow-up time was 4.4 mo (range 0.5-48.8). In treated area, ORR was highest in TARE_sorafenib (53.1%), followed by TARE_alone (41.3%) and TARE_no_sorafenib (16%). In intrahepatic area, DCR remained highest in TARE_sorafenib (84%), followed by TARE_alone (79.4%) and TARE_no_sorafenib (44%). The overall DCR was highest in TARE_alone (79.4%), followed by TARE_sorafenib (71.6%) and TARE_no_sorafenib (40%). Dominant failure patterns were intrahepatic for both TARE_alone (44.5%) and TARE_sorafenib (38.4%). Extrahepatic progression was more common in TARE_sorafenib (32%) and TARE_no_sorafenib (40%) than in TARE_alone (12.7%). TTP was longest in TARE_alone (8.6 mo; 95%CI: 3.4-13.8), followed by TARE_sorafenib (5.1 mo; 95%CI: 4.0-6.2) and TARE_no_sorafenib (2.7 mo; 95%CI: 2.2-3.1). Pre-existing EHD (HR: 0.37, 95%CI: 0.24-0.56, P < 0.001) was a sole prognostic factor for TTP in TARE_sorafenib with no prognostic factor for TTP in TARE_alone. CONCLUSION TARE with/without sorafenib according to individuals' disease burden provided DCR approximately 70% with intrahepatic progression as dominant failure pattern. Extrahepatic progression was more common in procedures with initially high disease burden.
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Affiliation(s)
- Ajalaya Teyateeti
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - James Long
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Mohamed Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Gregory Ravizzini
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Devaki Surasi
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Achiraya Teyateeti
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Homer Macapinlac
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Srinivas Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Subramanian S, Mallia MB, Shinto AS, Mathew AS. Clinical Management of Liver Cancer in India and Other Developing Nations: A Focus on Radiation Based Strategies. Oncol Ther 2021; 9:273-295. [PMID: 34046873 PMCID: PMC8593115 DOI: 10.1007/s40487-021-00154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global killer with preponderance in Asian and African countries. It poses a challenge for successful management in less affluent or developing nations like India, with large populations and limited infrastructures. This review aims to assess the available options and future directions for management of HCC applicable to such countries. While summarizing current and emerging clinical strategies for detection, staging and therapy of the disease, it highlights radioisotope- and radioactivity-based strategies as part of an overall program. Using the widely accepted Barcelona Clinic Liver Cancer (BCLC) staging system as a base, it evaluates the applicability of different therapeutic approaches and their synergistic combination(s) in the context of a patient-specific dynamic results-based strategy. It distills the conclusions of multiple HCC management-focused consensus recommendations to provide a picture of clinical strategies, especially radiation-related approaches. Additionally, it discusses the logistical and economic feasibility of these approaches in the context of the limitations of the burdened public health infrastructure in India (and like nations) and highlights possible strategies both at the clinical level and in terms of an administrative health policy on HCC to provide the maximum possible benefit to the widest swathe of the affected population.
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Affiliation(s)
- Suresh Subramanian
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India.
| | - Madhava B Mallia
- Radiopharmaceuticals Division, RLG Building, Bhabha Atomic Research Centre, Trombay, Mumbai, Maharashtra, 400085, India
| | - Ajit S Shinto
- Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
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20
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Garin E, Pinaquy JB, Bailly C, Sengel C, Mariano-Goulart D, Edeline J, Blanc JF, Bouvier A, Tordo J, Rode A, Becker S, Sefrioui D, de Baere T, Somma C, Mastier C, Goupil J, Chevallier P, Regnault H, Vibert E, Manfredi S, Vicaut E, Patel B, Boucher E, Guiu B. Evaluating the Effectiveness of Yttrium-90 Glass Microspheres in the Treatment of Hepatocellular Carcinoma, Intrahepatic Cholangiocarcinoma, and Metastatic Colorectal Cancer in Practice: Protocol for the Prospective PROACTIF Phase IV Registry Study in France. Cardiovasc Intervent Radiol 2021; 45:1-11. [PMID: 34796373 DOI: 10.1007/s00270-021-03002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE Recently, selective internal radiation therapy using yttrium-90 (Y90) glass microspheres (TheraSphere™) was approved for reimbursement by health authorities in France. The PROACTIF study aims to gather data on effectiveness, patient quality of life, and safety with use of Y90 glass microspheres in real-world clinical settings in France. INCLUSION CRITERIA Patient with a diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCC), and/or metastatic colorectal cancer (mCRC) who was treated with a dose of Y90 glass microspheres that has been reimbursed in France and who do not oppose use of their personal medical data. EXCLUSION CRITERIA If data collection is opposed, treatment is reimbursed but not administered, or treatment is administered but not reimbursed. OUTCOME MEASURES Primary outcome measures include overall survival from time of Y90 glass microsphere treatment and quality of life, as assessed using the Functional Assessment of Cancer Therapy- Hepatobiliary questionnaire. ESTIMATED NUMBER OF PATIENTS TO BE INCLUDED This is an open study and there is no set number of patients; 115 have already been enrolled. PLANNED SUBGROUP ANALYSES Analyses will be stratified by disease state (HCC, iCC, or mCRC). Subgroups to be analyzed include age group, unilobar/bilobar disease at baseline, Eastern Cooperative Oncology Group (ECOG) status at baseline, liver tumor burden at baseline, target lesion size, and standard versus multi-compartment personalized dosimetry treatment. PLANNED RECRUITMENT AND OBSERVATION PERIOD Recruitment includes patients who are prescribed and treated with a commercial vial of Y90 glass microspheres between 01 January 2019 and 31 December 2024. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04069468.
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Affiliation(s)
- Etienne Garin
- Nuclear Medicine Unit, Centre Eugene Marquis, Rennes, France
| | | | - Clement Bailly
- Nuclear Medicine Unit, University Hospital, Nantes, France
| | - Christian Sengel
- Radiology and Medical Imaging, CHU Hospital Michallon, Grenoble, France
| | | | | | - Jean-Frederic Blanc
- Hepatology, Gastroenterology, and Digestive Oncology, CHU Bordeaux, Bordeaux, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, Angers, France
| | - Jeremie Tordo
- Department of Nuclear Medicine, CHU Lyon Sud, Lyon, France
| | - Agnes Rode
- Department of Medical Imaging, CHU Lyon, Lyon, France
| | - Stéphanie Becker
- Departments of Medical Imaging and Nuclear Medicine, Centre Henri Bequerel, Rouen, France
| | - David Sefrioui
- Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
| | - Claude Somma
- Department of Nuclear Medicine, CHU La Timone, Marseille, France
| | - Charles Mastier
- Department of Radiology, CRLCC Centre Léon Bérard, Lyon, France
| | - Jean Goupil
- Department of Radiology and Medical Imaging, CHU Nimes, Nimes, France
| | | | - Helene Regnault
- Department of Hepatology, Henri Mondor Hospital, Creteil, France
| | - Eric Vibert
- Department of Hepatology and Surgery, Paul Brousse Hospital, Villejuif, France
| | - Sylvain Manfredi
- Department of Digestive Oncology, University Hospital, Dijon, France
| | - Eric Vicaut
- Clinical Trial Unit, AP-HP Groupe Hospitalier Lariboisière - Fernand-Widal, Paris, France
| | - Binal Patel
- Biostatistics, Boston Scientific Corporation, Marlborough, MA, USA
| | - Eveline Boucher
- Interventional Oncology, Boston Scientific Corporation, Marlborough, MA, USA
| | - Boris Guiu
- Department of Radiology, St. Eloi University Hospital - Montpellier School of Medicine, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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21
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Commander CW, Mauro DM. Current Approach to Planning Angiography and MAA Administration. Semin Intervent Radiol 2021; 38:397-404. [PMID: 34629705 DOI: 10.1055/s-0041-1735616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.
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Affiliation(s)
- Clayton W Commander
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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22
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Anh LT, Cuong PV, Ha NH, Thao HT. Intercomparison of Geant4 low energy electromagnetic models in 90Y dosimetry. Appl Radiat Isot 2021; 178:109938. [PMID: 34560513 DOI: 10.1016/j.apradiso.2021.109938] [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: 03/05/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
This work shows the comparison between Geant4 low energy electromagnetic physics lists G4EmLi-vermorePhysics, G4EmPenelopePhysics, G4EmLowEPPhysics, and G4EmDNAPhysics_option2 when simulating the energy deposition of low mono-energetic electrons and β- emitted from 90Y isotope. The simulation time and influence of production cut were considered. In the sense of balance between the accuracy and computer resource, G4EmPenelopePhysics can be proposed as the best physics model for our future Treatment Planning System (TPS) for treating liver cancer using 90Y microsphere radioembolization therapy.
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Affiliation(s)
- L T Anh
- Institute for Nuclear Science and Technology, Vietnam Atomic Energy Institute, Viet Nam
| | - P V Cuong
- Research and Development Center for Radiation Technology, Vietnam Atomic Energy Institute, Viet Nam.
| | - N H Ha
- Centre of Nuclear Physics, Institute of Physics, Vietnam Academy of Science and Technology, Viet Nam; M1 General Physics, Paris-Saclay University, 91405 Orsay Cedex, France
| | - H T Thao
- School of Mechanical Engineering, Kyungpook National University, South Korea
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Pan MM, Gabr A, Riaz A, Mouli S, Salem R, Lewandowski RJ. Does significantly elevated lung shunt fraction (LSF >20%) promote extrahepatic progression in patients with hepatocellular carcinoma treated with radioembolization? Nucl Med Commun 2021; 42:725-731. [PMID: 33660692 DOI: 10.1097/mnm.0000000000001392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Radioembolization with yttrium-90 (Y-90) is an effective locoregional therapy for primary and metastatic liver tumors, but its use is restricted or contraindicated for patients with elevated lung shunt fraction (LSF) because of an increased risk of developing pulmonary adverse events, including but not limited to radiation pneumonitis. Elevated LSF is also thought to be correlated with liver tumor progression and metastases. METHODS In this retrospective cohort study, we examine rates of metastasis development, rates of adverse events and overall survival (OS) in 23 patients with hepatocellular carcinoma (HCC) and elevated LSF >20% on Tc-99 m macroaggregated albumin scan treated with Y-90 radioembolization at our institution from 2005 to 2016. To minimize confounding variables, patients with baseline extrahepatic metastases or portal vein tumor thrombosis were excluded. Kaplan-Meier estimates were performed for OS and time to development of metastases. RESULTS No patient developed clinical and imaging signs of radiation pneumonitis. Median intention to treat OS from day of radioembolization was 21.3 months; median censored OS was 14.7 months. Five out of 23 patients (22%) developed at least one metastasis during follow-up, for an incidence of 20 per 1000 patient-years (compared to the historical rate of 6 per 1000 patient-years for HCC patients in general). CONCLUSION HCC patients with LSF >20% treated with Y-90 radioembolization have acceptable toxicities and appear to have a rate of extrahepatic tumor development (22%) higher than expected for patients with HCC.
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Affiliation(s)
- Michael M Pan
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
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d’Abadie P, Hesse M, Louppe A, Lhommel R, Walrand S, Jamar F. Microspheres Used in Liver Radioembolization: From Conception to Clinical Effects. Molecules 2021; 26:3966. [PMID: 34209590 PMCID: PMC8271370 DOI: 10.3390/molecules26133966] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/31/2023] Open
Abstract
Inert microspheres, labeled with several radionuclides, have been developed during the last two decades for the intra-arterial treatment of liver tumors, generally called Selective Intrahepatic radiotherapy (SIRT). The aim is to embolize microspheres into the hepatic capillaries, accessible through the hepatic artery, to deliver high levels of local radiation to primary (such as hepatocarcinoma, HCC) or secondary (metastases from several primary cancers, e.g., colorectal, melanoma, neuro-endocrine tumors) liver tumors. Several types of microspheres were designed as medical devices, using different vehicles (glass, resin, poly-lactic acid) and labeled with different radionuclides, 90Y and 166Ho. The relationship between the microspheres' properties and the internal dosimetry parameters have been well studied over the last decade. This includes data derived from the clinics, but also computational data with various millimetric dosimetry and radiobiology models. The main purpose of this paper is to define the characteristics of these radiolabeled microspheres and explain their association with the microsphere distribution in the tissues and with the clinical efficacy and toxicity. This review focuses on avenues to follow in the future to optimize such particle therapy and benefit to patients.
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Affiliation(s)
- Philippe d’Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (M.H.); (A.L.); (R.L.); (S.W.); (F.J.)
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Villalobos A, Soliman MM, Majdalany BS, Schuster DM, Galt J, Bercu ZL, Kokabi N. Yttrium-90 Radioembolization Dosimetry: What Trainees Need to Know. Semin Intervent Radiol 2020; 37:543-554. [PMID: 33328711 PMCID: PMC7732571 DOI: 10.1055/s-0040-1720954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alexander Villalobos
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed M. Soliman
- Weill Cornell Medicine – Qatar School of Medicine, Education City, Al Luqta St, Ar-Rayyan, Qatar
| | - Bill S. Majdalany
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David M. Schuster
- Division of Nuclear and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - James Galt
- Division of Nuclear and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L. Bercu
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Teyateeti A, Mahvash A, Long JP, Abdelsalam ME, Avritscher R, Chasen B, Kaseb AO, Kuban JD, Murthy R, Odisio BC, Teyateeti A, Macapinlac HA, Kappadath SC. Survival Outcomes for Yttrium-90 Transarterial Radioembolization With and Without Sorafenib for Unresectable Hepatocellular Carcinoma Patients. J Hepatocell Carcinoma 2020; 7:117-131. [PMID: 32984089 PMCID: PMC7500841 DOI: 10.2147/jhc.s248314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To assess the overall survival (OS) and progression-free survival (PFS) of unresectable hepatocellular carcinoma (HCC) patients undergoing yttrium-90 glass–microsphere transarterial radioembolization (TARE) with and without concurrent sorafenib. Methods OS and PFS were analyzed in 55 patients with an intrahepatic tumor (IHT) ≤50% without advanced or aggressive disease features (ADFs), which was referred to presence of infiltrative/ill-defined HCC, macrovascular invasion, or extrahepatic disease treated with only TARE (TARE_alone) and in 74 patients with IHT ≤50% with ADFs or IHT >50% treated with TARE and sorafenib (TARE_sorafenib). Prognostic factors for OS and PFS were identified using univariate and multivariate analyses. Results Median OS and PFS of TARE_alone patients were 21.6 (95% CI 6.1–37.1) and 9.1(95% CI 5.2–13.0) months, respectively, and for TARE_sorafenib patients 12.4 (95% CI 9.1–15.6) and 5.1 (95% CI 2.6–7.5) months, respectively. Better OS was associated with serum AFP <400 (HR 0.27, p=0.02) in TARE_alone, and IHT ≤50% (HR 0.39, p=0.004) and AFP <400 (HR 0.5, p=0.027) in TARE_sorafenib. Unilobar involvement (HR 0.43, p=0.029) and AFP <400 ng/mL (HR 0.52, p=0.015) correlated with better PFS in TARE_alone and TARE_sorafenib, respectively. Adverse events (AEs) were more frequent in TARE_sorafenib than TARE_alone (92.4 vs 80.3%), but only 9.3% were grade 3 or higher AEs. Conclusion TARE_alone provided the most prominent survival benefit in IHT ≤50%–without ADF patients who had unilobar HCC and serum AFP <400 ng/mL. TARE and sorafenib yielded the best outcomes in patients with IHT ≤50% and serum AFP <400 ng/mL, with some additional grade 1–2 AEs compared to TARE only.
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Affiliation(s)
- Ajalaya Teyateeti
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Armeen Mahvash
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James P Long
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Avritscher
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth Chasen
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua D Kuban
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ravi Murthy
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Achiraya Teyateeti
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Homer A Macapinlac
- Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Cheenu Kappadath
- Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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Aguado A, Dunn SP, Averill LW, Chikwava KR, Gresh R, Rabinowitz D, Katzenstein HM. Successful use of transarterial radioembolization with yttrium-90 (TARE-Y90) in two children with hepatoblastoma. Pediatr Blood Cancer 2020; 67:e28421. [PMID: 32603027 DOI: 10.1002/pbc.28421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary malignant liver tumors are rare but all require surgical resection as part of therapy with curative intent. A minority of patients have resectable tumors at diagnosis. Chemotherapy has a therapeutic role in hepatoblastoma but only one-third of patients have resectable disease at diagnosis. Two children with hepatoblastoma and suboptimal responses to initial chemotherapy received therapy with transarterial radioembolization utilizing yttrium-90 (TARE-Y90) and had significant response leading to resection and remission. The role of TARE-Y90 needs to be studied further to define its use in primary pediatric liver neoplasms.
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Affiliation(s)
- Allison Aguado
- Division of Interventional Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Stephen P Dunn
- Division of Pediatric Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Lauren W Averill
- Division of Interventional Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Kudakwashe R Chikwava
- Division of Anatomic Pathology, Department of Pathology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Renee Gresh
- Division of Hematology/Oncology and Bone Marrow Transplantation, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Deborah Rabinowitz
- Division of Interventional Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Howard M Katzenstein
- Division of Hematology/Oncology and Bone Marrow Transplantation, Nemours Children's, Specialty Care and Wolfson Children's Hospital, Jacksonville, Florida
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Sgouros G, Bodei L, McDevitt MR, Nedrow JR. Radiopharmaceutical therapy in cancer: clinical advances and challenges. Nat Rev Drug Discov 2020; 19:589-608. [PMID: 32728208 PMCID: PMC7390460 DOI: 10.1038/s41573-020-0073-9] [Citation(s) in RCA: 363] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 12/25/2022]
Abstract
Radiopharmaceutical therapy (RPT) is emerging as a safe and effective targeted approach to treating many types of cancer. In RPT, radiation is systemically or locally delivered using pharmaceuticals that either bind preferentially to cancer cells or accumulate by physiological mechanisms. Almost all radionuclides used in RPT emit photons that can be imaged, enabling non-invasive visualization of the biodistribution of the therapeutic agent. Compared with almost all other systemic cancer treatment options, RPT has shown efficacy with minimal toxicity. With the recent FDA approval of several RPT agents, the remarkable potential of this treatment is now being recognized. This Review covers the fundamental properties, clinical development and associated challenges of RPT.
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Affiliation(s)
- George Sgouros
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Lisa Bodei
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessie R Nedrow
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update. Cancers (Basel) 2020; 12:cancers12040791. [PMID: 32224882 PMCID: PMC7226474 DOI: 10.3390/cancers12040791] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) represents a significant contributor to cancer-related morbidity and mortality with increasing incidence in both developing and developed countries. Embolotherapy as a locoregional therapeutic strategy consists of trans-arterial or “bland” embolization (TAE), trans-arterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Trans-catheter arterial therapies can be applied along all stages of HCC, either as an alternative or neoadjuvant to surgical resection/transplantation in very early and early stage HCC or as a palliative option for local disease control in unresectable and advanced stage HCC. In advanced stage HCC, SIRT did not demonstrate superiority in comparison to systemic treatment options in several recent large prospective trials, though for carefully selected patients, may confer improved tolerability with similar disease control rates. The latest embolotherapeutic techniques and literature as they pertain to the management of HCC, as well as future directions, are reviewed in this article.
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30
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van Roekel C, Braat AJAT, Smits MLJ, Bruijnen RCG, de Keizer B, Lam MGEH. Radioembolization. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deipolyi AR, England RW, Ridouani F, Riedl CC, Kunin HS, Boas FE, Yarmohammadi H, Sofocleous CT. PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer. Cardiovasc Intervent Radiol 2019; 43:488-494. [PMID: 31732778 DOI: 10.1007/s00270-019-02375-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). MATERIALS AND METHODS From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. RESULTS Of the 68 post-RE scans, 6 were performed at 0-30 days, 15 at 31-60 days, 9 at 61-90 days, 13 at 91-120 days, 14 scans at 121-180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30-90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. CONCLUSION In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30-90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.
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Affiliation(s)
- Amy R Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ryan W England
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fourat Ridouani
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher C Riedl
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Kunin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Edward Boas
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ho CL, Chen S, Cheung SK, Leung TWT. Significant Value of 11C-Acetate and 18F-Fluorodeoxyglucose PET/Computed Tomography on 90Y Microsphere Radioembolization for Hepatocellular Carcinoma. PET Clin 2019; 14:459-467. [DOI: 10.1016/j.cpet.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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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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Aguado A, Ristagno R, Towbin AJ, Gupta A, Haberle S, Qi Z, Patel MN, Kukreja KU, Tiao GM, Geller JI. Transarterial radioembolization with yttrium-90 of unresectable primary hepatic malignancy in children. Pediatr Blood Cancer 2019; 66:e27510. [PMID: 30406959 DOI: 10.1002/pbc.27510] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary malignant liver tumors are rare, accounting for 1% to 2% of all childhood cancers. When chemotherapy fails, transarterial radioembolization with yttrium-90 (TARE-Y90) may offer an alternative therapy as a bridge to surgical resection or liver transplant or for palliation. METHODS We conducted a retrospective review of 10 pediatric patients with histologically confirmed primary liver malignancy who received treatment with TARE-Y90. RESULTS The median age at treatment was 5.5 years (range, 2-18 years). Median patient survival from initial diagnosis was 12.5 months (range, 10-28 months), and median patient survival after TARE-Y90 was 4 months (range, 2-20 months). Retreatment was well tolerated in three of 10 patients, with these patients demonstrating the longest survival times (range, 17-20 months). One patient was transplanted 6 weeks after TARE-Y90. By RECIST 1.1 criteria of all target lesions, eight of nine patients had stable disease, and one of nine had progressive disease. By mRECIST criteria (requiring postcontrast arterial phase imaging), two of seven patients had a partial response, four of seven had stable disease, and one of seven had progressive disease. CONCLUSION TARE-Y90 of unresectable primary liver malignancy is both technically feasible and demonstrates an anticancer effect, and retreatment is well tolerated. TARE-Y90 could be considered as adjunctive therapy in pediatric patients with unresectable hepatic malignancies and could be used as a bridge to surgical resection or liver transplant. More research is required to determine the efficacy of this treatment in children and to define the clinical scenarios where benefit is likely to be optimized.
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Affiliation(s)
- Allison Aguado
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | | | | | - Anita Gupta
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Sinisa Haberle
- Novant Health Hemby Children's Hospital, Charlotte, North Carolina
| | - Zhihua Qi
- Henry Ford Health System, Detroit, Michigan
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Radiation segmentectomy for hepatic malignancies: Indications, devices, dosimetry, procedure, clinical outcomes, and toxicity of yttrium-90 microspheres. J Interv Med 2019; 2:1-4. [PMID: 34805860 PMCID: PMC8562265 DOI: 10.1016/j.jimed.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Radiation segmentectomy (RS) is a new approach to 90Y radioembolization that has been designed to increase the safety and efficacy of radioembolization in patients with unresectable hepatic malignancies. With this technique, high doses (>190 Gy) of radiation are delivered to the tumor through radioembolization performed in a segmental fashion, potentially increasing the radiation dose to the tumor while minimizing injury to the liver parenchyma. The aim of this review is to provide a summary of the indications, device choice, dosimetry, procedure, clinical outcomes, and toxicity of RS based on the clinical series currently available.
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Pandey U, Subramanian S, Shaikh S, Gamre N, Kumar S, Dash A. Synthesis and Preliminary Biological Evaluation of 177Lu-Labeled Polyhydroxamic Acid Microparticles Toward Therapy of Hepatocellular Carcinoma. Cancer Biother Radiopharm 2019; 34:306-315. [PMID: 31188652 DOI: 10.1089/cbr.2018.2747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Transarterial radioembolization (TARE) represents an effective targeted therapeutic option for hepatocellular carcinoma (HCC), a cancer with high mortality and poor prognosis. The aim of this study was the preparation and preliminary biological evaluation of 177Lu-labeled polyhydroxamic acid (PHA) microparticles toward possible use in the therapy of HCC. Materials and Methods: PHA microparticles were synthesized starting from polyacrylamide. They were characterized by Fourier-transform infrared spectroscopy (FT-IR), visual color test, and laser diffraction particle size analysis. Experimental variables such as reaction pH, amount of PHA microparticles, carrier Lu content, and incubation time were optimized for maximum uptake of 177Lu on PHA microparticles. Stability of 177Lu-PHA microparticles was tested in the presence of competing Fe(III) ions in solution. In vitro stability of 177Lu-PHA microparticles was evaluated in 0.05 M sodium phosphate solution (pH 7.5), saline, and serum. Bioevaluation studies were performed in normal Wistar rats by intrahepatic artery injection of the 177Lu-PHA microparticles. Results: Successful synthesis of PHA microparticles could be confirmed from the results of FT-IR analysis and visual color test. Laser diffraction-based particle size analysis confirmed median particle size to be 54 μm, suitable for TARE. Under the optimized conditions, >99% loading of 177Lu on PHA microparticles could be achieved. Even in the presence of high concentration of Fe(III) ions, 177Lu binding to PHA microparticles was stable. 177Lu-PHA microparticles exhibited excellent in vitro stability in sodium phosphate solution, saline, and serum up to 5 d at 37°C. In the bioevaluation studies performed in normal Wistar rats, 92.8% ± 3.1% of 177Lu-PHA microparticles were retained in the liver at 96 h postinjection without any significant leakage to other organs. Conclusion: This preliminary study demonstrates the potential of synthesized PHA microparticles as carriers of therapeutic radioisotopes such as 177Lu for treatment of HCC.
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Affiliation(s)
- Usha Pandey
- 1 Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.,2 Homi Bhabha National Institute, Mumbai, India
| | - Suresh Subramanian
- 1 Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.,2 Homi Bhabha National Institute, Mumbai, India
| | - Samina Shaikh
- 2 Homi Bhabha National Institute, Mumbai, India.,3 Analytical Chemistry Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Naresh Gamre
- 1 Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Sanjukta Kumar
- 2 Homi Bhabha National Institute, Mumbai, India.,3 Analytical Chemistry Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Ashutosh Dash
- 1 Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.,2 Homi Bhabha National Institute, Mumbai, India
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Topcuoglu OM, Alan Selcuk N, Sarikaya B, Toklu T. Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion. Radiol Med 2019; 124:575-580. [DOI: 10.1007/s11547-018-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
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38
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Domouchtsidou A, Barsegian V, Mueller SP, Lobachevsky P, Best J, Horn PA, Bockisch A, Lindemann M. DNA lesions correlate with lymphocyte function after selective internal radiotherapy. Cancer Immunol Immunother 2019; 68:907-915. [PMID: 30877323 PMCID: PMC11028059 DOI: 10.1007/s00262-019-02323-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/11/2019] [Indexed: 12/24/2022]
Abstract
In patients with non-resectable hepatic malignancies selective internal radiotherapy (SIRT) with yttrium-90 is an effective therapy. However, previous data indicate that SIRT leads to impaired immune function. The aim of the current study was to determine the extent of DNA lesions in peripheral blood mononuclear cells of SIRT patients and to correlate these lesions with cellular immune responses. In ten patients γH2AX and 53BP1 foci were determined. These foci are markers of DNA double-strand breaks (DSBs) and occur consecutively. In parallel, lymphocyte proliferation was assessed after stimulation with the T cell mitogen phytohemagglutinin. Analyses of vital cells were performed prior to and 1 h and 1 week after SIRT. 1 h and 1 week after SIRT numbers of γH2AX and of 53BP1 foci were more than threefold larger than before (p < 0.01). Already at baseline, foci were more abundant than published in healthy controls. Lymphocyte proliferation at baseline was below the normal range and further decreased after SIRT. Prior to therapy, there was an inverse correlation between lymphocyte proliferation and the quotient 53BP1/γH2AX; which could be considered as a measure of the course of DNA DSB repair (r = - 0.94, p < 0.0001). Proliferative responses were inversely correlated with 53BP1 foci prior to therapy and γH2AX and 53BP1 foci 1 h after therapy (r < - 0.65, p < 0.05). In conclusion, DNA foci in SIRT patients were correlated with impaired in vitro immune function. Unrepaired DNA DSBs or cell cycle arrest due to repair may cause this impairment.
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Affiliation(s)
- Aglaia Domouchtsidou
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany
| | - Vahé Barsegian
- Institute of Nuclear Medicine, Helios Kliniken, Schwerin, Germany
| | - Stefan P Mueller
- Department of Nuclear Medicine, University Hospital, Essen, Germany
| | | | - Jan Best
- Department of Gastroenterology and Hepatology, University Hospital, Essen, Germany
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany.
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Feasibility assessment of yttrium-90 liver radioembolization imaging using amplitude-based gated PET/CT. Nucl Med Commun 2018; 39:222-227. [PMID: 29351124 PMCID: PMC5882249 DOI: 10.1097/mnm.0000000000000794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose The usage of PET/computed tomography (CT) to monitor hepatocellular carcinoma patients following yttrium-90 (90Y) radioembolization has increased. Respiratory motion causes liver movement, which can be corrected using gating techniques at the expense of added noise. This work examines the use of amplitude-based gating on 90Y-PET/CT and its potential impact on diagnostic integrity. Patients and methods Patients were imaged using PET/CT following 90Y radioembolization. A respiratory band was used to collect respiratory cycle data. Patient data were processed as both standard and motion-corrected images. Regions of interest were drawn and compared using three methods. Activity concentrations were calculated and converted into dose estimates using previously determined and published scaling factors. Diagnostic assessments were performed using a binary scale created from published 90Y-PET/CT image interpretation guidelines. Results Estimates of radiation dose were increased (P<0.05) when using amplitude-gating methods with 90Y PET/CT imaging. Motion-corrected images show increased noise, but the diagnostic determination of success, using the Kao criteria, did not change between static and motion-corrected data. Conclusion Amplitude-gated PET/CT following 90Y radioembolization is feasible and may improve 90Y dose estimates while maintaining diagnostic assessment integrity.
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40
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Validation of response to yttrium-90 radioembolization for hepatocellular carcinoma with portal vein invasion. J Hepatol 2018; 69:259-260. [PMID: 29548768 DOI: 10.1016/j.jhep.2018.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/26/2018] [Accepted: 02/01/2018] [Indexed: 12/04/2022]
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41
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Domouchtsidou A, Barsegian V, Mueller SP, Best J, Ertle J, Bedreli S, Horn PA, Bockisch A, Lindemann M. Impaired lymphocyte function in patients with hepatic malignancies after selective internal radiotherapy. Cancer Immunol Immunother 2018; 67:843-853. [PMID: 29500633 PMCID: PMC11028233 DOI: 10.1007/s00262-018-2141-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/23/2018] [Indexed: 12/19/2022]
Abstract
The purpose of our study was to assess the immune function of patients with inoperable hepatic malignancies after treatment with selective internal radiotherapy (SIRT) and to identify possible correlations with clinical parameters. In 25 patients receiving SIRT lymphocyte proliferation and the production of pro- and anti-inflammatory cytokines (interferon-γ and interleukin-10) after stimulation with mitogens and microbial antigens were tested prior to therapy, directly after therapy (day 1) and at day 2, 7 and 28 post therapy using the lymphocyte transformation test and enzyme-linked immunospot assays. Absolute counts and percentages of leukocyte and lymphocyte subsets were determined by flow cytometry. The most prominent finding was an immediate and significant (p < 0.05) decrease of lymphocyte proliferation and interferon-γ production directly after therapy which lasted until day 28 and was stronger upon stimulation with microbial antigens than with mitogens. Moreover, lymphopenia was revealed, affecting all lymphocyte subsets (CD3+, CD4+, CD8+ T cells, CD4+ CD8+ T cells, B cells and NK cells). SIRT led to a reduction in the percentage of activated HLA-DR+ monocytes and of CD45R0+ memory T cells. Higher radiation activity, the presence of liver cirrhosis, chronic kidney disease, diabetes mellitus and metastases were unfavorable factors for immunocompetence, while a better Eastern Cooperative Oncology Group performance status was associated with stronger immunological reactions. In conclusion, SIRT leads to severe impairment of cellular in vitro immune responses. Further studies are needed to assess a potential clinical impact.
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Affiliation(s)
- Aglaia Domouchtsidou
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany
| | - Vahé Barsegian
- Institute of Nuclear Medicine, Helios Kliniken, Schwerin, Germany
| | - Stefan P Mueller
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Jan Best
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Judith Ertle
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Sotiria Bedreli
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, Virchowstraße 179, 45147, Essen, Germany.
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Najran P, Lamarca A, Mullan D, McNamara MG, Westwood T, Hubner RA, Lawrence J, Manoharan P, Bell J, Valle JW. Update on Treatment Options for Advanced Bile Duct Tumours: Radioembolisation for Advanced Cholangiocarcinoma. Curr Oncol Rep 2018; 19:50. [PMID: 28656502 PMCID: PMC5487900 DOI: 10.1007/s11912-017-0603-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is a rare form of gastrointestinal cancer with a poor prognosis. Patients often present with biliary obstruction or non-specific abdominal pain, and a high proportion of patients have advanced disease at initial diagnosis. The goal of this review is to discuss treatment options for patients with advanced bile duct tumours focusing on radioembolisation (RE) and its impact on overall survival. RE provides a therapeutic option for patients with unresectable cholangiocarcinoma. However, although systemic chemotherapy has demonstrated a survival benefit in randomised controlled trials, there is limited supporting evidence for the use of RE in this setting. Studies are mostly limited to single-centre, small cohorts with variable outcome measures. Additionally, patients included in these studies received a variety of previous therapies including chemotherapy, surgery or alternative intra-arterial therapy; therefore, a true assessment of overall survival benefit is difficult.
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Affiliation(s)
- Pavan Najran
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Damian Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,Division of Molecular and Clinical Cancer Sciences; Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, M13 9PL, UK
| | - Thomas Westwood
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Jeremy Lawrence
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Prakash Manoharan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jon Bell
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK. .,Division of Molecular and Clinical Cancer Sciences; Institute of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, M13 9PL, UK.
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Kinetic analysis of contralateral liver hypertrophy after radioembolization of primary and metastatic liver tumors. Surgery 2018; 163:1020-1027. [PMID: 29325784 DOI: 10.1016/j.surg.2017.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Radioembolization induces liver hypertrophy, although the extent and rate of hypertrophy are unknown. Our goal was to examine the kinetics of contralateral liver hypertrophy after transarterial radioembolization. METHODS A retrospective study (2010-2014) of treatment-naïve patients with primary/secondary liver malignancies undergoing right lobe radioembolization was performed. Computed tomography volumetry was performed before and 1, 3, and 6 months after radioembolization. Outcomes of interest were left lobe (standardized future liver remnant) degree of hypertrophy, kinetic growth rate, and ability to reach goal standardized future liver remnant ≥40%. Medians were compared with the Kruskall-Wallis test. Time to event analysis was used to estimate time to reach goal standardized future liver remnant. RESULTS In the study, 25 patients were included. At 1, 3, and 6 months, median degree of hypertrophy was 4%, 8%, and 12% (P < .001), degree of hypertrophy relative to baseline future liver remnants was 11%, 17%, and 31% (P = .015), and kinetic growth rate was 0.8%, 0.5%, and 0.4%/week (P = .002). In patients with baseline standardized future liver remnant <40% (N= 16), median time to reach standardized future liver remnant ≥40% was 7.3 months, with 75% accomplishing standardized future liver remnant ≥40% at 8.2 months. CONCLUSION Radioembolization induces hypertrophy of the contralateral lobe to a similar extent as existing methods, although at a lower rate. The role of radioembolization as a dual therapy (neoadjuvant and hypetrophy-inducing) for selected patients needs to be studied. (Surgery 2017;160:XXX-XXX.).
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44
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Mouli SK, Goff LW. Local Arterial Therapies in the Management of Unresectable Hepatocellular Carcinoma. Curr Treat Options Oncol 2017; 18:67. [DOI: 10.1007/s11864-017-0509-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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45
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Hashikin NAA, Yeong CH, Guatelli S, Abdullah BJJ, Ng KH, Malaroda A, Rosenfeld A, Perkins AC. Systematic investigation on the validity of partition model dosimetry for90Y radioembolization using Monte Carlo simulation. ACTA ACUST UNITED AC 2017; 62:7342-7356. [DOI: 10.1088/1361-6560/aa7e5b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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46
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Wang EA, Broadwell SR, Bellavia RJ, Stein JP. Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma. J Gastrointest Oncol 2017; 8:266-278. [PMID: 28480066 PMCID: PMC5401864 DOI: 10.21037/jgo.2016.11.08] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) often present at stages where patients have limited treatment options. Use of selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) resin microspheres has progressed as data increasingly speak to its utility in patients with both intermediate and late stage disease in these cancers. In anticipation of the pending completion of several prospective randomized controlled multicenter studies exploring the use of Y-90 resin microspheres in primary liver cancers, this article outlines mechanisms involved in SIRT administration and reviews key efficacy and safety data that are currently available in the literature involving use of this therapy in both HCC and ICC.
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Affiliation(s)
- Eric A Wang
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Ross J Bellavia
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
| | - Jeff P Stein
- Charlotte Radiology, Carolinas Medical Center, Charlotte, NC, USA
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Indicators of Lung Shunt Fraction Determined by Technetium-99 m Macroaggregated Albumin in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2017; 40:1213-1222. [DOI: 10.1007/s00270-017-1619-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/02/2017] [Indexed: 12/13/2022]
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48
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Comparison of the Adverse Event Profile of TheraSphere® with SIR-Spheres® for the Treatment of Unresectable Hepatocellular Carcinoma: A Systematic Review. Cardiovasc Intervent Radiol 2017; 40:1033-1043. [DOI: 10.1007/s00270-017-1594-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/31/2017] [Indexed: 12/16/2022]
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49
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Maas L. Yttrium-90 radioembolization as a palliative treatment for liver tumors: a case study. Clin J Oncol Nurs 2017; 19:620-2. [PMID: 26414581 DOI: 10.1188/15.cjon.620-622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The best chance of cure for patients with liver cancer is surgical removal, but many tumors are too large or invasive. In addition, chemotherapy is frequently unsuccessful in this patient population. A case study is featured involving a patient determined to be a candidate for Yttrium-90 radioembolization, a minimally invasive liver-directed treatment used to target primary and metastatic liver tumors by delivering radioactive microspheres directly to the tumor. This article provides an introduction to the procedure, as well as practical information for nurses caring for patients with liver cancer following Yttrium-90 radioembolization.AT A GLANCE: Yttrium-90 radioembolization allows larger radiation doses to be used without affecting healthy tissues.An outpatient procedure, Yttrium-90 radioembolization results in fewer side effects than standard treatment.
Although Yttrium-90 radioembolization can extend and improve quality of life, its intent is palliative, not curative.
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Affiliation(s)
- Lisa Maas
- Greater Milwaukee Critical Care and Pulmonary Associates
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50
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Ahmed O, Patel MV, Masrani A, Chong B, Osman M, Tasse J, Soni J, Turba UC, Arslan B. Assessing Intra-arterial Complications of Planning and Treatment Angiograms for Y-90 Radioembolization. Cardiovasc Intervent Radiol 2017; 40:704-711. [PMID: 28078375 DOI: 10.1007/s00270-016-1555-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 12/22/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To report hepatic arterial-related complications encountered during planning and treatment angiograms for radioembolization and understand any potential-associated risk factors. MATERIALS AND METHODS 518 mapping or treatment angiograms for 180 patients with primary or metastatic disease to the liver treated by Yttrium-90 radioembolization between 2/2010 and 12/2015 were retrospectively reviewed. Intra-procedural complications were recorded per SIR guidelines. Patient demographics, indication for treatment, prior exposure to chemotherapeutic agents, operator experience, and disease burden were reviewed. Technical variables including type of radioembolic (glass vs. resin microspheres), indication for angiography (mapping vs. treatment), variant anatomy, and attempts at coil embolization were also assessed. RESULTS Thirteen (13/518, 2.5%) arterial-related complications occurred in 13 patients. All but two complications resulted during transcatheter coil embolization to prevent non-target embolization. Complications included coil migration (n = 6), arterial dissection (n = 2), focal vessel perforation (n = 2), arterial thrombus (n = 2), and vasospasm prohibiting further arterial sub-selection (n = 1). Transarterial coiling was identified as a significant risk factor of complications on both univariate and multivariate regression analysis (odds ratio 7.8, P = 0.004). Usage of resin microspheres was also a significant risk factor (odds ratio 9.5, P = 0.042). No other technical parameters or pre-procedural variables were significant after adjusting for confounding on multivariate analysis (P > 0.05). CONCLUSION Intra-procedural hepatic arterial complications encountered during radioembolization were infrequent but occurred mainly during coil embolization to prevent non-target delivery to extra-hepatic arteries.
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Affiliation(s)
- Osman Ahmed
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA.
| | - Mikin V Patel
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Abdulrahman Masrani
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Bradford Chong
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Mohammed Osman
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Jordan Tasse
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Jayesh Soni
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Ulku Cenk Turba
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
| | - Bulent Arslan
- Section of Interventional Radiology, Department of Radiology, Rush University Medical Center, 1725 W. Harrison Street, Suite 450, Chicago, IL, 60612, USA
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