Radioembolization: Concepts and Procedures

  1. Arbizu, Javier 1
  2. Bilbao, José I. 1
  3. Garrastachu, Puy 1
  4. Rodriguez-Fraile, Macarena 1
  5. Domínguez-Prado, Inés 1
  6. Iñarrairaegui, Mercedes 1
  7. Sangro, Bruno 1
  1. 1 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

Libro:
Therapeutic Nuclear Medicine

Editorial: Springer

ISSN: 0942-5373,  2197-4187

ISBN: 9783540367185,  9783540367192

Año de publicación: 2014

Páginas: 361-377

Tipo: Capítulo de Libro

beta Ver similares en nube de resultados
DOI: 10.1007/174_2012_793 GOOGLE SCHOLAR lock_openAcceso abierto editor

Resumen

Radioembolization (RE) is a form of intravascular brachytherapy that consists in delivering implantable radioactive microspheres into the arteries that feed liver tumors in order to provide a high dose of radiation to tumor nodules irrespective of their number, size, and location, while preserving the non-tumoral liver tissue from receiving a harmful level of radiation. The nature of the procedure using Yttrium-90 RE (Y-90 RE) requires the collaboration of a multidisciplinary team including hepatologists or oncologists, interventional radiologists and nuclear medicine specialists working together in close collaboration. To avoid toxicity, a thorough angiographic evaluation is performed to identify every extrahepatic vessel that may feed the tumors (to assure efficiency), accomplished with Tc-99m labeled macroaggregated albumin (Tc-MAA) injection into the vessel of interest, in order to mimic the microsphere application during the treatment. Both procedures combined are essential to plan the radioembolization (RE) therapy and to detect any occult arteriovenous shunt from the hepatic arterial system to the pulmonary or gastrointestinal venous systems and so identify potentially to calculate the degree of hepatopulmonary shunting, and to detect and eventually occlude every collateral vessel that arising from a hepatic artery may carry microspheres to the GI tract or other extrahepatic organs. With all this information, the treatment is designed and activity is calculated in order to maximize the dose of radiation delivered to liver tumors while safely preserving the non-tumoral parenchyma.

Referencias bibliográficas

  • Ahmadzadehfar H, Biersack HJ, Ezziddin S (2010) Radioembolization of liver tumors with yttrium-90 microspheres. Semin Nucl Med 40:105–121
  • Bangash AK, Atassi B, Kaklamani V et al (2007) 90Y radioembolization of metastatic breast cancer to the liver: toxicity, imaging response, survival. J Vasc Interv Radiol 18:621–628
  • Bilbao JI, de Martino A, de Luis E, Díaz-Dorronsoro L et al (2009) Biocompatibility, inflammatory response, and recannalization characteristics of nonradioactive resin microspheres: histological findings. Cardiovasc Intervent Radiol 32:727–736
  • Bilbao JI, Garrastachu M, Herraiz MJ et al (2010) Safety and efficacy assessment of flow redistribution by occlusion of intra-hepatic vessels prior to radioembolization in the treatment of liver tumours. Cardiovasc Intervent Radiol 33:523–531
  • Boan JF, Valero M, Arbizu J (2008) Improving treatment design by image fusion techniques. In: Bilbao JI, Reiser MF (eds) Liver radioembolization with 90Y microspheres. Springer-Verlag, Berlin, pp 61–73
  • Bockisch A, Freudenberg LS, Schmidt D, Kuwert T (2009) Hybrid imaging by SPECT/CT and PET/CT: proven outcomes in cancer imaging. Semin Nucl Med 39:276–289
  • Carr BI (2004) Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transpl 10:S107–S110
  • Carretero C, Muñoz-Navas M, Betés M et al (2007) Gastroduodenal injury after radio-embolization of hepatic tumours. Am J Gastroenterol 102:1–5
  • Cosin O, Bilbao JI, Alvarez S et al (2007) Right gastric artery embolization prior to treatment with yttrium-90 microspheres. Cardiovasc Intervent Radiol 30:98–103
  • Covey AM, Brody LA, Maluccio MA et al (2002) Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 224:542–547
  • Denecke T, Ruhl R, Hildebrandt B et al (2008) Planning transarterial radioembolization of colorectal liver metastases with yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques. Eur Radiol 18:892–902
  • Even-Sapir E, Keidar Z, Bar-Shalom R (2009) Hybrid imaging (SPECT/CT and PET/CT)—improving the diagnostic accuracy of functional/metabolic and anatomic imaging. Semin Nucl Med 39:264–275
  • Gulec SA, Mesoloras G, Dezarn WA et al (2007) Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: the tumor selectivity of the treatment as a function of tumor to liver flow ratio. J Transl Med 5:15
  • Gunji H, Cho A, Tohma T et al (2006) The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 192:276–280
  • Hamami ME, Poeppel TD, Müller S et al (2009) SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer. J Nucl Med 50:688–692
  • Ho S, Lau WY, Leung TWT, Chan M, Ngar YK, Johnson PJ et al (1996) Partition model for estimating radiation doses from yttrium-90 microspheres in treating hepatic cancer. Eur J Nucl Med 23:947–952
  • Ho S, Lau W, Leung W et al (1997) Tumour-to-normal uptake ratio of 90Y microspheres in hepatic cancer assessed with 99mTc macroaggregated albumin. Br J Radiol 70:823–828
  • Ibrahim SM, Mulcahy MF, Lewandowski RJ et al (2008) Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study. Cancer 113:2119–2128
  • Jakobs TF, Hoffmann RT, Fischer T et al (2008) Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol 19:683–690
  • Kennedy A, Nag S, Salem R et al (2007) Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 68:13–23
  • Kennedy AS, Mac Neille P, Dezarn WA et al (2009) Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys 74:1494–1500
  • Kim DE, Yoon H-K, Ko GY, Kwon JS, Song H-Y, Sung K-B (1999) Hepatic falciform artery: is prophylactic embolization needed before short-term hepatic arterial chemoinfusion? AJR Am J Roentgenol 172:1597–1599
  • Koch W, Tatsch K (2008) Nuclear medicine procedures for treatment evaluation. In: Bilbao JI, Reiser MF (eds) Liver radioembolization with 90Y microspheres. Springer-Verlag, Berlin, pp 75–91
  • Lau WY, Leung TWT, Ho S, Chan M, Leung N, Lin J et al (1994) Diagnostic pharmaco-scintigraphy with technetium-99m macroaggregated albumin in the prediction of tumor to normal uptake ratio during therapy of inoperable hepatocellular carcinoma with yttrium-90 microspheres. Br J Radiol 67:136–139
  • Lau WY, Ho S, Leung TW, Chan M, Ho R, Johnson PJ, Li AK (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90Yttrium microspheres. Int J Radiation Oncol Biol Phys 40:583–592
  • Leung TW, Lau WY, Ho SK et al (1995) Radiation pneumonitis after selective internal radiation treatment with intraarterial 90 yttrium microspheres for inoperable hepatic tumours. Int J Radiat Oncol Biol Phys 33:919–924
  • Leong QM, Lai HK, Lo RG et al (2009) Radiation dermatitis following radioembolization for hepatocellular carcinoma: a case for prophylactic embolization of a patent falciform artery. J Vasc Interv Radiol 20:833–836
  • Lewandowski RJ, Sato KT, Atassi B et al (2007) Radio-embolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30:571–592
  • Lhommel R, Goffette P, Van den Eynde M, Jamar F, Pauwels S, Bilbao JI, Walrand S (2009) Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging 36:1696
  • Liu DM, Salem R, Bui JT et al (2005) Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Intervent Radiol 16:911–935
  • Michels N (1955) Blood supply and anatomy of the upper abdominal origins with a descriptive atlas. JB Lippincott, Philadelphia, pp 147–148
  • Miyayama S, Matsui O, Taki K et al (2006) Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 29:39–48
  • Nicolay NH, Berry DP, Sharma RA (2009) Liver metastases from colorectal cancer: radioembolization with systemic therapy. Nat Rev Clin Oncol 6:687–697
  • Rhee TK, Lewandowski RJ, Liu DM et al (2008) 90Y Radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 247:1029–1035
  • Riaz A, Lewandowski RJ, Kulik LM et al (2009) Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 20:1121–1130
  • Rodríguez-Fraile M, Arbizu J, Iñarrairaegui M, Martí-Climent J, Quincoces G, Garrastachu P, Domínguez I, Peñuelas I, Sangro B, Richter JA (2008) Evaluation of 99mTc-MAA SPECT as a biomarker of liver tumor response to radioembolization with 90-yttrium. Eur J Nucl Med Mol Imaging 35(Suppl 2):S278
  • Salem R, Hunter RD (2006) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma: a review. Int J Radiat Oncol Biol Phys 66(suppl 2):S83–S88
  • Salem R, Thurston KG (2006) Radioembolization with 90yttrium Microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies part 1: technical and methodologic considerations. J Vasc Interv Radiol 17:1251–1278
  • Salem R, Lewandowski RJ, Ryu RK et al (2008) Radioembolization: identifying and managing anatomic variants. In: Bilbao JI, Reiser MF (eds) Liver radioembolization with 90Y Microspheres. Medical Radiology, Diagnostic Imaging, pp 43–50
  • Sangro B, Bilbao JI, Boan J, Martinez-Cuesta A et al (2006) Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 66:792–800
  • Sangro B, Gil-Alzugaray B, Rodriguez J et al (2008) Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 112:1538–1546
  • Sangro B, Bilbao JI, Iñarrairaegui M, Rodriguez M et al (2009) Treatment of hepatocellular carcinoma by radioembolization using 90Y microspheres. Dig Dis 27:164–169
  • Sirtex medical training manual, training program physicians and institutions. Sirtex Medical Limited, Australia. Available at: http://www.sirtex.com/usa/_data/page/549/TRN-US-0320for20US1.pdf
  • Song SY, Chung JW, Lim HG et al (2006) Nonhepatic arteries originating from hepatic arteries: angiographic analysis in 250 patients. J Vasc Intervent Radiol 17:461–469
  • TheraSphere yttrium-90 glass microspheres users manual. MDS Nordion, Ottawa, ON, Canada. http://www.nordion.com/therasphere/physicians-package-insert/package-insert-eu-en.pdf
  • Wallace MJ, Murthy R, Kammat PP et al (2007) Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Inter 18:1500–1507
  • Yoon CJ, Chung JW, Cho BH et al (2008) Hepatocellular carcinoma in the caudate lobe of the liver: angiographic analysis of tumor-feeding arteries according to subsegmental localization. J Vasc Intervent Radiol 19:1543–1550