Safety of Radioembolization with 90Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels

Abstract

Purpose To evaluate the safety of radioembolization (RE) with 90 Yttrium ( 90 Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. Materials and MethodsEarly and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group). Results Clinically relevant late toxicities (CGrade 3) were observed in 1 % of our overall cohort. The no-coiling group had significantly less ''any'' (P = 0.0001) or ''clinically relevant'' (P = 0.0003) early toxicity. There was no significant difference (P [ 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures. Conclusion RE with 90 Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.

Reply: High Impact of Preferential Flow on 99mTc-MAA and 90Y-Loaded Microsphere Uptake Correlation

“…Second, we experienced only a very limited number of vasospasms during angiography. We did coil embolization of aberrant vessels in only a limited proportion of patients and only during therapeutic angiography (14); therefore, vasospasms caused by prolonged diagnostic angiographies cannot explain the low 99m Tc-MAA uptake and higher microsphere uptake as proposed by Garin et al Furthermore, in most cases 1-3 wk elapse between diagnostic and therapeutic angiography. Considering the highly dynamic biology of cancer, it is not likely that tumor perfusion stays stable over time, and this instability is also a factor impairing the comparability of 99m Tc-MAA and microsphere uptake.…”

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review

“…Paprottka et al [ 17 ] and Powerski et al [ 15 ] were considered to be of best quality: both studied a large cohort with even distribution between patients who were embolized or not, and both included a well-defined and extensive follow-up period (respectively 24 weeks and 12 months) (Fig. 2 ).…”

“…Five studies used clinical and/or laboratory parameters during follow-up [ 12 , 13 , 16 – 18 ]. Paprottka et al [ 17 ] was the only study that classified the clinical complications of non-target embolization using standardized criteria, namely the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAEv3.0) [ 20 ] and differentiated between early complications (within a week after treatment) and late complications (up to 6 months). Complications of grade ≥3 were considered clinically relevant.…”

Radioembolisation

“…mindestens kontrastverstärkte, biphasische Computertumografie (inklusive CT-Angiografie) ggf. 18 fel lieber ein aberrantes Gefäß mehr als eins zu wenig verschließen sollte [1]. In Zusammenschau mit den Ergebnissen der morphologischen Bildgebung werden anschließend die Katheterpositionen für die spätere Radioembolisation festgelegt und exakt an diesen Positionen das mit 99 m Tc-markierte makroaggregierte Albumin (MAA) über den einliegenden Superselektivkatheter injiziert.…”

“…Nach der Applikation des mit 99 m Tc-markierten makroaggregierten Albumins liegt zunächst eine stabile Verteilung des Die szintigrafischen Aufnahmen nach der Tc-Angiografie haben [1,7]. Prinzipiell besitzen klinisch relavante Toxizitäten eher einen Seltenheitswert, solange die Sphären ausschließlich in die Leber und in keine sonstigen parenchymatösen Organe gelangen.…”