Serious hepatic complications of selective internal radiation therapy with yttrium‐90 microsphere radioembolization for unresectable liver tumors

Kuo, James; Tazbirkova, Andrea; Allen, Robert J.; Kosmider, Suzanne; Gibbs, Peter; Yip, Desmond

doi:10.1111/ajco.12229

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…Results from the SIRveNIB comparing SIRT with Sorafenib demonstrated no statistically significant differences in overall survival however progression free survival and time to progression in patients treated with SIRT vs Sorafenib with a similar trend demonstrated in the SARAH trial[82,83]. Complication rates of up to 4.9% and a mortality rate of 1.5% were reported in one multi-centre Australian study[84]. The most common complications were post-embolisation syndrome (0-70%) and Radiation-induced liver disease (0-31%).…”

Section: Sirtmentioning

confidence: 72%

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Inchingolo

Posa

Mariappan

et al. 2019

WJG

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Liver cancers are the second most frequent cause of global cancer-related mortality of which 90% are attributable to hepatocellular carcinoma (HCC). Despite the advent of screening programmes for patients with known risk factors, a substantial number of patients are ineligible for curative surgery at presentation with limited outcomes achievable with systemic chemotherapy/external radiotherapy. This has led to the advent of numerous minimally invasive options including but not limited to trans-arterial chemoembolization, radiofrequency/microwave ablation and more recently selective internal radiation therapy many of which are often the first-line treatment for select stages of HCC or serve as a conduit to liver transplant. The authors aim to provide a comprehensive overview of these various image guided minimally invasive therapies with a brief focus on the technical aspects accompanied by a critical analysis of the literature to assess the most up-to-date evidence from comparative systematic reviews and meta-analyses finishing with an assessment of novel combination regimens and future directions of travel.

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Section: Sirtmentioning

confidence: 72%

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Inchingolo

Posa

Mariappan

et al. 2019

WJG

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“…Our uniformly-sized 188 Re-MS constitute one of the first efforts to produce a 188 Re-labeled radioembolization agent made of a blend of fully biodegradable polymers. Current radioembolization agents are retained in the patient's capillary bed indefinitely due to their non-biodegradable nature, thus preventing reopening of the clogged capillaries after radioembolization 58-60. Once lodged in the capillaries, the polymer chains in the 188 Re-MS will slowly break down into smaller polyester fragments, which will be absorbed and recycled by the body in the form of lactic acid.…”

Section: Resultsmentioning

confidence: 99%

Radioembolization of Hepatocellular Carcinoma with Built-In Dosimetry: First in vivo Results with Uniformly-Sized, Biodegradable Microspheres Labeled with ¹⁸⁸Re

et al. 2019

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A common form of treatment for patients with hepatocellular carcinoma (HCC) is transarterial radioembolization (TARE) with non-degradable glass or resin microspheres (MS) labeled with 90 Y ( 90 Y-MS). To further simplify the dosimetry calculations in the clinical setting, to have more control over the particle size and to change the permanent embolization to a temporary one, we developed uniformly-sized, biodegradable 188 Re-labeled MS ( 188 Re-MS) as a new and easily imageable TARE agent. Methods: MS made of poly( L -lactic acid) were produced in a flow focusing microchip. The MS were labeled with 188 Re using a customized kit. An orthotopic HCC animal model was developed in male Sprague Dawley rats by injecting N1-S1 cells directly into the liver using ultrasound guidance. A suspension of 188 Re-MS was administered via hepatic intra-arterial catheterization 2 weeks post-inoculation of the N1-S1 cells. The rats were imaged by SPECT 1, 24, 48, and 72 h post-radioembolization. Results: The spherical 188 Re-MS had a diameter of 41.8 ± 6.0 µm ( CV = 14.5%). The site and the depth of the injection of N1-S1 cells were controlled by visualization of the liver in sonograms. Single 0.5 g tumors were grown in all rats. 188 Re-MS accumulated in the liver with no deposition in the lungs. 188 Re decays to stable 188 Os by emission of β ¯ particles with similar energy to those emitted by 90 Y while simultaneously emitting γ photons, which were imaged directly by single photon computed tomography (SPECT). Using Monte Carlo methods, the dose to the tumors was calculated to be 3-6 times larger than to the healthy liver tissue. Conclusions: 188 Re-MS have the potential to become the next generation of β ¯ -emitting MS for TARE. Future work revolves around the investigation of the therapeutic potential of 188 Re-MS in a large-scale, long-term preclinical study as well as the evaluation of the clinical outcomes of using 188 Re-MS with different sizes, from 20 to 50 µm.

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“…REILD may manifest with a wide spectrum of clinical manifestations, including abdominal pain, jaundice, and ascites, and laboratory abnormalities, including hyperbilirubinemia, elevated alkaline phosphatase, and gamma-glutamyl transpeptidase ( 6 ). Most patients can be treated conservatively, but some cases may progress to hepatic failure ( 65 66 ). Therefore, for the determination of treatment protocols, both treatment efficacy and potential liver toxicity should be considered.…”

Section: Complicationsmentioning

confidence: 99%

Imaging Evaluation Following ⁹⁰Y Radioembolization of Liver Tumors: What Radiologists Should Know

Joo

Kim

et al. 2018

Korean J Radiol

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Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.

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Serious hepatic complications of selective internal radiation therapy with yttrium‐90 microsphere radioembolization for unresectable liver tumors

Cited by 11 publications

References 27 publications

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Radioembolization of Hepatocellular Carcinoma with Built-In Dosimetry: First in vivo Results with Uniformly-Sized, Biodegradable Microspheres Labeled with ¹⁸⁸Re

Imaging Evaluation Following ⁹⁰Y Radioembolization of Liver Tumors: What Radiologists Should Know

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Serious hepatic complications of selective internal radiation therapy with yttrium‐90 microsphere radioembolization for unresectable liver tumors

Cited by 11 publications

References 27 publications

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Locoregional treatments for hepatocellular carcinoma: Current evidence and future directions

Radioembolization of Hepatocellular Carcinoma with Built-In Dosimetry: First in vivo Results with Uniformly-Sized, Biodegradable Microspheres Labeled with 188Re

Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know

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Radioembolization of Hepatocellular Carcinoma with Built-In Dosimetry: First in vivo Results with Uniformly-Sized, Biodegradable Microspheres Labeled with ¹⁸⁸Re

Imaging Evaluation Following ⁹⁰Y Radioembolization of Liver Tumors: What Radiologists Should Know