Pathologic response and microdosimetry of 90Y microspheres in man: Review of four explanted whole livers

Kennedy, Andrew S.; Nutting, Charles; Coldwell, Douglas M.; Gaiser, James; Drachenberg, Cinthia

doi:10.1016/j.ijrobp.2004.09.004

Cited by 376 publications

(278 citation statements)

References 53 publications

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“…The number of microspheres in a 3 GBq resin vial can be ≤80-fold greater than the same activity of glass spheres based on the time from calibration (1). Potentially, resin Y90 can better saturate larger tumors and improve outcomes given the greater number of microspheres with preferential clustering in the viable, hypervascular portion of target masses (10). However, the theoretical benefit of more complete tumor coverage has been incompletely realized as incomplete delivery of the prescribed activity potentially decreases efficacy or the result in earlier time to progression.…”

Section: Discussionmentioning

confidence: 99%

Five percent dextrose maximizes dose delivery of Yttrium-90 resin microspheres and reduces rates of premature stasis compared to sterile water

et al. 2016

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Abstract. Resin Yttrium-90 (Y90) microspheres have historically been infused using sterile water (H 2 O). In 2013, recommendations expanded to allow delivery with 5% dextrose in water (D 5 W). In this retrospective study, we hypothesized that D 5 W would improve Y90 delivery with a lower incidence of stasis. We reviewed 190 resin Y90 infusions using H 2 O (n=137) or D 5 W (n=53). Y90 dosimetry was calculated using the body surface area method. IntroductionYttrium-90 (Y90) microspheres are used to treat patients with primary hepatic and liver-dominant metastatic cancer. The glass and resin Y90 products differ significantly in the density of radionuclide per bead. Glass microspheres have a higher density [2,500 Becquerel (Bq)/bead] of Y90 than resin (50 Bq/bead) (1). The higher Y90 concentration in glass beads allows the delivery of prescribed activity without feeding artery occlusion, a known issue with resin microspheres. From the time of government approval in 2002, the standard technique for infusion of resin microspheres used sterile water (H 2 O) alternating with small aliquots of contrast to evaluate for arterial stasis prior to delivery of the entire dose vial (2,3). While clinical outcomes have resulted in excellent control of hepatic disease, a previous review using H 2 O to inject resin microspheres identified a 20% early stasis rate (4-6).Delivering less than the prescribed Y90 activity has the potential to reduce treatment efficacy or result in earlier time to progression. Therefore, investigation of other injection methods for resin microspheres is required. In 2013, our group began to use 5% dextrose in water (D 5 W) as an alternative to H 2 O (7).The aim of the current study was to measure the incidence of premature stasis using D 5 W in comparison to H 2 O. We hypothesized that D 5 W induces stasis less frequently than H 2 O in a clinical cohort of patients with primary or secondary hepatic malignancy. Materials and methodsClinical setting and patients. Our Institutional Review Board approved this retrospective study. All the procedures performed were in accordance with the ethical standards of the Vanderbilt University School of Medicine and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.We retrospectively reviewed laboratory, radiology and nuclear pharmacy reports of all resin Y90 infusions performed between July, 2013 and July, 2014. Consecutive patients treated after September, 2013, were treated with

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Section: Discussionmentioning

confidence: 99%

Five percent dextrose maximizes dose delivery of Yttrium-90 resin microspheres and reduces rates of premature stasis compared to sterile water

et al. 2016

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“…Overlaid are the 100 Gy (blue) and the 1000 Gy (red) isodose curves. Reproduced with permission [15] O' Doherty Page 30…”

Section: Discussionmentioning

confidence: 99%

“…Using a MC dose deposition technique, the heterogeneous nature of dose distribution with ranges of 25 Gy to 3,000 Gy over a 4 cm area for 4 explanted livers was shown [15]. An example of this high dose range is shown in Figure 2.…”

Section: Microsphere Distributionmentioning

confidence: 97%

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

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“…No significant amount of Y-90 leaches from the microspheres, and it decays to stable zirconium-90 with a half-life of 2.67 days (64.2 h). The microspheres are suspended in sterile, pyrogen-free water for injection [7,13].…”

Section: Methodsmentioning

confidence: 99%

Radiation Safety Issues in Y-90 Microsphere Selective Hepatic Radioembolization Therapy: Possible Radiation Exposure from the Patients

Kim

Uhm

et al. 2010

Nucl Med Mol Imaging

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Purpose The purpose of this study was to estimate the possible external radiation dose to other individuals from patients treated with Y-90 resin microspheres for unresectable hepatocellular carcinoma. Methods We designed the study prospectively to estimate the possible radiation dose to other individuals from patients who had been treated with Y-90 microspheres for unresectable hepatocellular carcinoma. We estimated the total effective dose equivalent (TEDE) using two methods: 'theoretical' TEDEs according to the administered activity and 'measured' TEDE based on the 'measured' ambient radiation exposure rate. We compared the results from each method to determine when we can release patients from confinement at the earliest time complying with the patient release criteria. Results A total of 20 administrations of Y-90 resin microspheres were done in 18 patients. The average administered activity was 1.2±0.77 (0.28-2.97) GBq. The 'theoretical' TEDEs were in the range of 0.8-10 μSv. The 'measured' TEDEs were in the range of 2.31-185 μSv. The measured TEDEs tend to be higher than the theoretical TEDEs. The values of theoretical and measured TEDE were both far less than 1 mSv, the upper limit at which the licensee can release a patient without any written documents. Conclusion The effective dose equivalent caused by the Y-90 microsphere administered patient is very low. It is safe in terms of radiation safety to the other individuals when Y-90 microsphere radioembolization therapy is done with dose less than 3 GBq. Because the measured TEDE tends to be higher than the theoretical TEDE, it is recommended to use 'measured' TEDE for determining patient release.

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Pathologic response and microdosimetry of 90Y microspheres in man: Review of four explanted whole livers

Cited by 376 publications

References 53 publications

Five percent dextrose maximizes dose delivery of Yttrium-90 resin microspheres and reduces rates of premature stasis compared to sterile water

Five percent dextrose maximizes dose delivery of Yttrium-90 resin microspheres and reduces rates of premature stasis compared to sterile water

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Radiation Safety Issues in Y-90 Microsphere Selective Hepatic Radioembolization Therapy: Possible Radiation Exposure from the Patients

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