90Y Microspheres: Concepts and Principles

Kennedy, Andrew S.; Dezarn, William A.; McNeillie, Patrick

doi:10.1007/174_2013_820

Cited by 3 publications

(5 citation statements)

References 38 publications

(30 reference statements)

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“…Prior studies have also identified total delivered radiation dose, treatment of the right lobe, and increased number of prior liver treatments as risk factors for hepatic decompensation. 10 21 22 One recently published study in 2023 by Lee et al has now demonstrated lower overall survival and progression-free survival in patients with Child-Pugh class B compared to A, median score 6. 27 This in conjunction with our study's findings of three to fourfold elevated risk of hepatic decompensation with Child-Pugh class B and odds of severe decompensation increasing by a factor of 2.15 for every unit increase in score over 6 suggests that preprocedural evaluation of Child-Pugh score should be routine.…”

Section: Discussionmentioning

confidence: 99%

“…21 22 The most serious complication is radioembolization-induced liver disease that has a reported incidence of up to 6.7%. 10 24 25 26 It is characterized by elevated bilirubin and liver enzymes—specifically alkaline phosphatase, ascites, or jaundice approximately 2 weeks to 4 months after radiation. Risk increases with age, baseline bilirubin levels, whole-liver treatment, and use of the empiric method for dose calculation.…”

Section: Discussionmentioning

confidence: 99%

“…Risk increases with age, baseline bilirubin levels, whole-liver treatment, and use of the empiric method for dose calculation. 10 22 Unfortunately, evaluation of postprocedural hepatic dysfunction is complicated by the preexisting dysfunction inherent in many HCC patients especially those with cirrhosis. Sangro et al demonstrated that even in patients without chronic liver disease, 20% developed clinical hepatic dysfunction within 4 to 8 weeks of treatment, all of whom had received chemotherapy prior to radioembolization.…”

Section: Discussionmentioning

confidence: 99%

“…Desired therapeutic goal and optimal dosimetry is an ongoing area of research; however, care is trending toward a personalized dosimetry approach. 8 9 10 11 12 Absolute contraindications to TARE include functional liver reserve less than 700 cc and uncorrectable liver shunt to gastrointestinal (GI) tract or lungs with potential for more than 30 Gy radiation exposure, decompensated liver function, hepatic encephalopathy, and pregnancy. Relative contraindications include more than 20% pulmonary shunt, elevated total bilirubin more than 2 mg/dL, abdominal ascites, severe portal hypertension, and prior external beam radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Hepatic Decompensation after Yttrium90 Transarterial Radioembolization—Optimizing Patient Selection

Wong,

Cheng,

Herrera

et al. 2024

Journal of Clinical Interventional Radiology ISVIR

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Objective Yttrium 90 (Y90) transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma (HCC) or to bridge/downstage before transplant; however, optimal patient selection is not well-described. This study aims to identify factors that increase risk of liver decompensation resulting in hospital admissions after TARE. Methods Patients who received Y90 as their first treatment during 2012 to 2022 were identified from a prospectively collected database of 1675 HCC patients. Clinically significant hepatic decompensation was defined as total bilirubin more than or equal to 3 mg/dL or any increase in Model for End-stage Liver Disease (MELD) score resulting in readmission within 60 days or death. Results Of 137 patients, 7 (5.1%) developed hepatic decompensation requiring admission within 30 days and an additional 8 (10.9%) within 60 days. Two of these patients (1.4%) died and two (1.4%) required urgent transplant within 2 months. Preprocedure albumin less than 3.5 gm/dL (p = 0.0207), international normalized ratio more than 1.2 (p = 0.017), ascites (p = 0.036), elevated MELD (p = 0.012), and Child-Pugh (p = 0.007) scores were significant predictors of decompensation, while creatinine and sodium were not. Patients with Child-Pugh B score were three to four times more likely to decompensate (28 vs. 8%) compared to Child-Pugh A. For every unit increase in Child-Pugh score more than 6, odds of decompensation increased by a factor of 2.15. Conclusion Y90 TARE is safe and effective; however, 10.9% patients require readmission for worsened liver function. Because ascites is a significant factor in predicting decompensation and all patients require adequate renal function to receive Y90 TARE, Child-Pugh score may be more useful than MELD for patient selection. Further risk stratification may be required for those with a Child-Pugh score more than or equal to 7.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Hepatic Decompensation after Yttrium90 Transarterial Radioembolization—Optimizing Patient Selection

Wong,

Cheng,

Herrera

et al. 2024

Journal of Clinical Interventional Radiology ISVIR

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“…20 Radioembolization involves injection of microspheres incorporating the radioisotope Yttrium-90 intra-arterially into the liver. 21 Although liver transplantation may provide long-term recurrence-free survival in some patients, the majority ultimately develop recurrent disease. 22…”

Section: Casementioning

confidence: 99%