Angiographic Considerations in Patients Undergoing Liver-directed Therapy

Liu, David M.; Salem, Riad; Bui, James T.; Courtney, Angi; Barakat, Omar; Sergie, Ziad; Atassi, Basel; Barrett, Karen; Gowland, Patricia; Oman, Beth; Lewandowski, Robert J.; Gates, Vanessa L.; Thurston, Kenneth G.; Wong, Ching Yee Oliver

doi:10.1097/01.rvi.0000164324.79242.b2

Cited by 221 publications

(135 citation statements)

References 88 publications

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“…These previously published standards were applied to our cohort. 22,23,25 Centers that use this technology are encouraged to apply these basic principles to maximize the safety profile and to optimize long-term outcomes. The highly localized radiation effect translated to an imaging response rate of 40.6% with a corresponding TTHP of 15.4 months and a response duration of 15 months.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, consideration should be made for prophylactic coil embolization of extrahepatic vessels before Y90 infusion to minimize the possibility of nontarget embolization. [22][23][24] To mitigate these risks further, all patients were treated prophylactically with proton-pump inhibitors. Despite these precautions, we did encounter 1 treatment-related gastric ulcer that responded to conservative therapy.…”

Section: Discussionmentioning

confidence: 99%

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Radioembolization of colorectal hepatic metastases using yttrium‐90 microspheres

Mulcahy

Lewandowski

Ibrahim

et al. 2009

Cancer

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157

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BACKGROUND:The objective of the current study was to determine the safety and efficacy of Yttrium‐90 (Y90) microsphere treatment in patients with liver‐dominant colorectal metastases.METHODS:Seventy‐two patients with unresectable hepatic colorectal metastases were treated at a targeted absorbed dose of 120 Gray (Gy). Safety and toxicity were assessed using version 3 of the National Cancer Institute Common Terminology Criteria. Response was assessed by anatomic imaging and positron emission tomography (PET). Survival from the diagnosis of hepatic metastases and first treatment were estimated using the Kaplan‐Meier method. Substratification analyses were performed.RESULTS:The median dose delivered was 118 Gy. Treatment‐related toxicities included fatigue (61%), nausea (21%), and abdominal pain (25%). Grade 3 and 4 bilirubin toxicities were observed in 9 of 72 patients (12.6%). The tumor response rate was 40.3%. The median time to hepatic progression was 15.4 months, and the median response duration was 15 months. The PET response rate was 77%. Overall survival from the first Y90 treatment was 14.5 months. Tumor replacement (≤25% vs >25%) was associated with significantly greater median survival (18.7 months vs 5.2 months). The presence of extrahepatic disease was associated negatively with overall survival (7.9 months vs 21 months). Overall survival from the date of initial hepatic metastases was 34.6 months. A subset analysis of patients who had an Eastern Cooperative Oncology Group performance status of 0 demonstrated a median survival of 42.8 months and 23.5 months from the time of hepatic metastases and Y90 treatment, respectively.CONCLUSIONS:Y90 liver therapy appears to provide sustained disease stabilization with acceptable toxicity. Asymptomatic patients with preserved liver function at the time of Y90 appeared to benefit most from treatment. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radioembolization of colorectal hepatic metastases using yttrium‐90 microspheres

Mulcahy

Lewandowski

Ibrahim

et al. 2009

Cancer

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157

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“…In view of the high variability of the hepatic arterial bed and the relevance of vascular anatomy, as described in Shepherd et al [10], a detailed angiographic evaluation of the splanchnic arteries needs to be performed to identify tumor feeding vessels and, more importantly, hepatofugal vessels [17]. Considering the potentially deleterious effect of a dystopic spread of radioactive microspheres into extrahepatic sites such as the stomach, duodenum, or pancreas, it is important to ensure that there is no hepatofugal flow.…”

Section: Patient Preparationmentioning

confidence: 99%

Standards of Practice in Transarterial Radioembolization

Mahnken

Spreafico

Maleux

et al. 2013

Cardiovasc Intervent Radiol

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“…2). These arteries include the inferior phrenic, intercostals, and internal mammary arteries [17,20,21].…”

Section: Procedural Considerationsmentioning

confidence: 99%

“…Meticulous angiographic technique, use of pressure injectors, and good quality digital subtraction angiography systems are necessary for complete evaluation of the angioarchitecture of the tumor and all the feeders. It is important to target all the arterial feeders for getting a good response [17].…”

Section: Procedural Considerationsmentioning

confidence: 99%

Interventional Radiological Treatment of Hepatocellular Carcinoma: An Update

2011

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Hepatocellular carcinoma is the commonest primary liver tumor and its incidence is on an increase. Transplantation and surgical resection are the gold standard curative treatment options but less than 20%patients are surgical candidates because of advanced liver disease and/ or co-morbidities.Various interventional radiological procedures have been developed and intensively investigated for treatment of inoperable HCC.This review summarizes the various interventional radiological treatments in HCC including patient selection, procedural considerations and response evaluation. Transarterial chemoembolization, radioembolization and radiofrequency ablation are mainly discussed.

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Angiographic Considerations in Patients Undergoing Liver-directed Therapy

Cited by 221 publications

References 88 publications

Radioembolization of colorectal hepatic metastases using yttrium‐90 microspheres

Radioembolization of colorectal hepatic metastases using yttrium‐90 microspheres

Standards of Practice in Transarterial Radioembolization

Interventional Radiological Treatment of Hepatocellular Carcinoma: An Update

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