Radiation Dermatitis following Radioembolization for Hepatocellular Carcinoma: A Case for Prophylactic Embolization of a Patent Falciform Artery

Leong, Quor Meng; Lai, Hee Kit; Lo, Richard G.H.; Teo, T.; Goh, Anthony; Chow, Pierce K. H.

doi:10.1016/j.jvir.2009.03.011

Cited by 48 publications

(26 citation statements)

References 14 publications

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“…Bremsstrahlung scan showed radioactivity in the region of the falciform ligament, and a diagnosis of radiation dermatitis was made. The patient was treated with oral steroids, remained clinically stable and recovered within 5 weeks [3]. Similar complications due to patent hepatic falciform arteries have also been reported to affect transcatheter arterial chemoembolization (TACE) for unresectable HCC [7][8][9].…”

Section: Discussionmentioning

confidence: 98%

“…Periumbilical pain is uncommon after radioembolization and may be due to inadvertent delivery of Y-90 microspheres into arteries supplying the anterior abdominal wall via a patent hepatic falciform artery [2]. Non-target localization of Y-90 microspheres along the hepatic falciform ligament has recently been described as a cause of acute radiation dermatitis of the anterior abdominal wall [3]. We report two patients in which hepatic falciform ligament radiotracer activity was identified during routine pre-therapy Technetium-99m-macroaggregated albumin (Tc-99m-MAA) single photon emission computed tomography with integrated low-dose CT (SPECT/CT) imaging, which allowed active measures to be taken to avoid radiationinduced complications to the anterior abdominal wall post-SIRT.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

et al. 2011

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Yttrium-90 (Y-90) selective internal radiation therapy (SIRT) is increasingly used to treat inoperable hepatocellular carcinoma. We describe two patients where hepatic falciform ligament Technetium-99m-macroaggregated albumin (Tc-99m-MAA) activity was identified on single photon emission computed tomography with integrated low-dose CT (SPECT/CT) scan during pre-therapy planning, and the steps taken to prevent radiation dermatitis. The first patient underwent prophylactic coil embolization of the patent hepatic falciform artery; the second patient underwent super-selective infusion of Y-90 resin microspheres to avoid the patent hepatic falciform artery. The incidence of falciform ligament Tc-99m-MAA activity detected on SPECT/CT at our institution is 10%. Tc-99m-MAA SPECT/CT scan provides valuable diagnostic information for treatment planning prior to Y-90 SIRT.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

et al. 2011

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“…The total amount of the activity to be applied to the liver may need to be reduced depending on the pulmonary shunt value; the implementation of the treatment may even be contraindicated. In the case of unexpected accumulation of an excessive amount of Y-90 microspheres in the stomach, duodenum, gall bladder, pancreas, and mesentery, this treatment is not applicable because severe complications (such as gastrointestinal ulceration, bleeding, gastritis, duodenitis, cholecystitis, pancreatitis, radiation dermatitis, and pneumonia) may arise (12,13). Systemic treatments often deteriorate the hepatic artery flow by affecting the morphological structure in neoplastic tissue and even in normal parenchyma.…”

Section: Radioembolization Application Principlesmentioning

confidence: 99%

Radioembolization Treatment for Liver Cancer

Erdoğan¹,

Özdemir²,

Aydın³

2016

Bezmialem Science

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Although curative treatment is surgery (resection/transplantation) and for small lesions ablative strategies, in primary liver carcinomas such as hepatocellular carcinoma and cholangiocellular carcinoma, palliative treatment is used for most of these patients because of lack of surgical options. These treatments are regional treatments such as transarterial chemoembolization, radiofrequency ablation, or microwave ablation and systemic treatments such as tyrosine kinase inhibitors. Surgery and chemotherapy are the main treatment options for metastatic liver tumors, particularly in colorectal tumors, although local treatment options are used for these patients. In recent years, transarterial radioembolization with yttrium-90 microsphere has emerged as a local treatment option in primary and metastatic liver tumors. The aim of this treatment is to provide an effective radiation dose distribution for the tumor in the liver tissue and to give the lowest dose in order to not harm the intact liver tissue. Radioembolization has proven to be as effective as other available palliative treatments in primary and secondary liver tumors and is a treatment method that is well tolerated. It has a risk for serious life-threatening complications, although this rate is low. Toxicity can be kept at a minimum with adequate technical and rigorous application in experienced hands and in accordance with multidisciplinarity. It is hoped that the effectiveness of radioembolization is further increased in the future by technological developments, researches on dosimetry, its use along with radiosensitizing agents, and various treatment combinations.Keywords: Radioembolization, Yttrium-90 microsphere, liver treatment IntroductionHepatocellular carcinoma (HCC) is one of the world's most common abdominal malignancies. Most patients have an underlying liver disease. The stage of tumor and the functional capacity of the liver determine the prognosis. A practical staging system based on the tumor burden, the liver function reserve, physical condition, and symptoms associated with cancer was developed by the Barcelona group (Barcelona Clinic Liver Cancer, BCLC). The tumor burden is determined by the number of tumors, size of tumor, portal vein invasion, or presence of extrahepatic metastasis. Here, the functional reserve of the liver is determined according to the Child-Pugh staging system (consists of serum albumin and bilirubin levels, the presence of acid and encephalopathy, prothrombin time/INR findings) and the physical condition is determined according to the performance classification of the Eastern Cooperative Oncology Group (ECOG). This staging system and accordingly, the overall treatment approach are summarized in Table 1 (1, 2).While only 30%-40% of patients are appropriate for curative treatment (resection, transplantation and ablation for small lesions), the vast majority of about 60% is in the middle (B) or advanced (C) stage (2). The general prognosis is poor in these patients with no potential curative treatment. Until n...

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“…This is particularly important when microspheres could be inadvertently deposited in excessive amounts in organs other than the liver such as stomach, duodenum, gallbladder, pancreas, mesentery, and also in vascular structures such as the falciform artery. Serious complications include gastrointestinal ulceration, bleeding, gastritis, duodenitis, cholecystitis, pancreatitis, radiation dermatitis, and pneumonitis (Leong et al 2009;Riaz et al 2009;Liu et al 2005).…”

Section: Extrahepatic Vessels (Unnoticed Collateralmentioning

confidence: 99%