Hepatic Flow Redistribution is Feasible in Patients with Hepatic Malignancies Undergoing Same-Day Work-Up Angiography and Yttrium-90 Microsphere Radioembolization

Abstract

Purpose To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. Materials and Methods From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99m Technetium-labeled macroaggregated albumin ( 99m Tc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99m Tc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = \ 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test.Results Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. Conclusion Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.

The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

“…When multiple extra or intrahepatic vessels feeding the TgV were detected, a selective catheterization of each one was carried out. Thus, same-day flow redistribution was performed, when deemed necessary, to treat the complete tumoral area reducing the number of injection points [ 19 , 20 ].…”

SIRT in 2025

“…The possibility to perform a single-day SIRT reduced the disadvantages of RE (typically requiring at least two visits) compared to other locoregional therapies: RE can be safely performed with pre-treatment diagnostic angiography, dosimetry evaluation, and therapeutic SIRT in the same day [111][112][113][114][115][116].…”

Combination of intrahepatic TARE and extrahepatic TACE to treat HCC patients with extrahepatic artery supply: A case series

“…Moreover, as TARE can be proposed as a salvage therapy for lesions over 5 cm in diameter, most patients have already had several previous treatments: i.e., surgery, systemic treatment, ablations, or TACE [7] , [8] , [9] , [10] , [11] . Thus, lesions may have arterial abnormalities induced by tumor progression or previous embolizations, leading to the recruitment of extrahepatic feeding arteries (EHFA), especially in the case of peripherally located tumors [12] , [13] , [14] . However, TARE cannot be performed through an EHFA as the risk of delivering radiation to non-target territories is elevated and burdened by major complications [13] .…”

“…However, TARE cannot be performed through an EHFA as the risk of delivering radiation to non-target territories is elevated and burdened by major complications [13] . Thus, embolization of EHFAs has been proposed to redistribute arterial flow to the liver lesion [12] , [13] , [14] , facilitating effective redistribution of the radiation dose during TARE performed solely through the hepatic arteries. Essentially, two techniques have been proposed: coiling or embolization with particles of the EHFA [ 12 , 14 , 15 ].…”

“…The first option was described as being ineffective due to the opening of shunts around the EHFA [ 14 , 15 ]. Conversely, the second option seems reliable in redistributing the flow to the intrahepatic branches, but it risks occluding the vascularization to a part of the lesion [12] which consequently will not be treated during TARE and thus not receive the appropriate radiation dose.…”