Streamlining TARE or personalizing SIRT? Different philosophies to treat different HCCs with Yttrium-90…

Edeline, Julien; Garin, Étienne

doi:10.1016/j.jhep.2020.03.026

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…Unlike TACE, which is often complicated with PES and requires inpatient hospitalization, TARE has been associated with a better quality of life and patient experience, as it can be performed in an outpatient setting [ 13 ]. More specifically, radiation segmentectomy using 90Y is indicated for the TARE treatment of small hepatic tumors less than 3 cm in diameter in a segmental manner [ 4 , 14 ]. While this can be achieved via the use of either glass microspheres or resin microspheres, a retrospective study of 90 patients indicated bilirubin and AST toxicities occurred at rates 2.8-fold and 2.6-fold higher in 90Y-resin microspheres compared to glass microspheres [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Post-embolization Syndrome Following Yttrium-90 Radiation Segmentectomy

Vanani¹,

Janardan²,

Asmi³

et al. 2023

Cureus

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Post-embolization syndrome (PES) is a complication that commonly occurs after treatment with transarterial embolization for hepatocellular carcinoma (HCC). Patients with PES often present with clinical symptoms such as fever, nausea, abdominal pain, and elevated liver enzymes typically 24-72 hours after the procedure. While cases of PES have been documented in patients treated with transarterial chemoembolization, here, we present an unusual case of delayed onset PES in a 70-year-old male with HCC following treatment with a form of transarterial radioembolization.

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Section: Discussionmentioning

confidence: 99%

Post-embolization Syndrome Following Yttrium-90 Radiation Segmentectomy

Vanani¹,

Janardan²,

Asmi³

et al. 2023

Cureus

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“…In the majority of cases within these series, the only imaging performed for dose calculation was planar scintigraphy, which allows for a short time interval between mapping and delivery. However, planar scintigraphy does not provide necessary information for more personalized dosimetry, which can maximize therapeutic effect while minimizing adverse events in certain patients[ 16 , 17 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, a randomized trial of patients with HCC by Garin et al [ 26 ] found that personalized dosimetry with SPECT/CT resulted in improved response rates and overall survival in patients with advanced HCC. As proposed in recent literature, a potential strategy may be the use of only planar scintigraphy (or even no LSF fraction evaluation) in patients with small peripheral tumors, and the use of SPECT/CT in patients with more complex malignancies who are likely to benefit from personalized dosimetry[ 16 ]. More research is necessary to elucidate an optimal treatment algorithm for same day therapy.…”

Section: Discussionmentioning

confidence: 99%

“…A study by Gabr et al [ 15 ] even proposed eliminating Tc-99m MAA scans entirely in patients with United Network for Organ Sharing stage T1/T2 hepatocellular carcinoma (HCC) without prior transjugular intrahepatic portosystemic shunt (TIPS), since hepatopulmonary shunting is low and dose can be easily calibrated for segmental injections[ 15 ]. Conversely, more complex malignancies such as in patients with larger tumors, multiple lesions, prior TIPS placement, and other lesions at high risk for hepatopulmonary shunting may necessitate personalized dosimetry for good treatment response after Y-90 RE[ 16 , 17 ]. SPECT/CT analysis also enables detailed assessment of arterial supply and extrahepatic uptake[ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

Elsayed¹,

Loya²,

Galt³

et al. 2021

WJGO

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BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access. AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy. METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles. RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day. CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.

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“…When using resin microspheres, same-day SIRT may represent another option to reduce the need for hospitalization, in well-selected patients [ 45 ]. Recent papers have also suggested that the preliminary diagnostic work up could be avoided in specific situations, such as patients with small HCC and without TIPS, who are candidates for radiation segmentectomy, since in these conditions, the risk of clinically significant lung shunting is minimal, tumor targeting and extrahepatic uptake can be ruled out using intraprocedural cone-beam CT and dosimetry can be calculated on the basis of the whole liver and target liver volumes on baseline cross-sectional imaging and intraprocedural cone-beam CT [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT)

Bargellini¹,

Boni

Traino

et al. 2021

JCM

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Background: In the context of the coronavirus disease 2019 (COVID-19) pandemic, liver-directed therapies (LDTs) may offer minimally invasive integrative tools for tumor control. Among them, selective internal radiation therapy (SIRT) represents a safe, flexible and effective treatment. Purpose of this study is to present our experience with SIRT during the first wave of COVID-19 pandemic and provide an overview of the indications and challenges of SIRT in this scenario. Methods: We retrospectively analyzed the number of patients evaluated by Multidisciplinary Liver Tumor Board (MLTB) and who were undergoing LDTs between March and July 2020 and compared it with 2019. For patients treated with SIRT, clinical data, treatment details and the best radiological response were collected. Results: Compared to 2019, we observed a 27.5% reduction in the number of patients referred to MLTB and a 28.3% decrease in percutaneous ablations; transarterial chemoembolizations were stable, while SIRT increased by 64%. The majority of SIRT patients (75%) had primary tumors, mostly HCC. The best objective response and disease control rates were 56.7% and 72.2%, respectively. Conclusion: The first wave of the COVID-19 pandemic was characterized by an increased demand for SIRT, which represents a safe, flexible and effective treatment, whose manageability will further improve by simplifying the treatment workflow, developing user-friendly and reliable tools for personalized dosimetry and improving interdisciplinary communication.

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Streamlining TARE or personalizing SIRT? Different philosophies to treat different HCCs with Yttrium-90…

Cited by 4 publications

References 16 publications

Post-embolization Syndrome Following Yttrium-90 Radiation Segmentectomy

Post-embolization Syndrome Following Yttrium-90 Radiation Segmentectomy

Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

Management of Liver Tumors during the COVID-19 Pandemic: The Added Value of Selective Internal Radiation Therapy (SIRT)

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