The Role of Tumor Vascularity in Predicting Survival after Yttrium-90 Radioembolization for Liver Metastases

Sato, Kent T.; Omary, Reed A.; Takehana, Christopher; Ibrahim, Saad M.; Lewandowski, Robert J.; Ryu, Robert K.; Salem, Riad

doi:10.1016/j.jvir.2009.08.013

Cited by 55 publications

(46 citation statements)

References 15 publications

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“…Cholangiocellular carcinomas with a high 99m Tc-MAA uptake even showed a trend toward shorter survival (51 wk) than those with low uptake (median survival not reached). Similar results were reported by two other studies (9,10). These findings underline the complexity of tumor biology.…”

Section: Replysupporting

confidence: 91%

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

Haug

Ilhan

2016

J Nucl Med

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Section: Replysupporting

confidence: 91%

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

Haug

Ilhan

2016

J Nucl Med

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“…This difference in 99m Tc-MAA application method would naturally have resulted in major differences of uptake in the liver parenchyma and likewise in the tumor, with unpredictable effects on the TBR. Not surprisingly, MAM and CRC had low uptake values; these tumor entities often appear hypovascularized on contrastenhanced CT and on angiography (13). Supporting our data, almost half the CRC liver metastases in another study had a lower uptake than that of liver parenchyma (8).…”

Section: Discussionsupporting

confidence: 76%

“…Significant differences between vascularization of tumors as assessed during angiography and 99m Tc-MAA uptake on SPECT are described. Therefore, conclusions derived from contrast enhancement of tumors have to be drawn with caution, especially as results derived from angiography and cross-sectional imaging are contradictory in some cases (13,14).…”

Section: Discussionmentioning

confidence: 99%

Systematic Evaluation of Tumoral ^99mTc-MAA Uptake Using SPECT and SPECT/CT in 502 Patients Before ⁹⁰Y Radioembolization

Ilhan¹,

Goritschan²,

Paprottka³

et al. 2015

J Nucl Med

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The aim of this study was to evaluate the 99m Tc-macroaggregated albumin ( 99m Tc-MAA) uptake of primary and secondary liver tumors in a large patient cohort before 90 Y radioembolization. Methods: We included 502 patients during the years 2005-2013 (55% male; mean age, 62 ± 11 y), who were examined with 99m Tc-MAA SPECT or SPECT/CT before planned radioembolization. The patients had colorectal cancer (CRC; n 5 195, 38.8%), neuroendocrine tumors (NET; n 5 77, 15.3%), mammary cancer (MAM; n 5 68, 13.5%), hepatocellular carcinoma (HCC; n 5 59, 11.8%), cholangiocellular carcinoma (CCC; n 5 40, 8.0%), or urologic tumors (URO; n 5 14, 2.8%). SPECT with coregistered contrast-enhanced CT or MR imaging and SPECT/CT images of these patients were analyzed using dedicated software with regard to the 99m Tc-MAA uptake of the liver tumors. Regions of interest were drawn around the lesions manually and quantified the uptake of up to 3 lesions per patient and also adjacent healthy liver tissue without evidence of tumor. We quantified maximum and mean counts per pixel and calculated tumor-to-background ratio (TBR). Data are reported as mean ± SD. Lesion uptake was classified as being homogeneously high (grade 1), heterogeneously high (grade 2), equal to that of the liver (grade 3), or low (grade 4). In quantitative analysis, the mean TBR max of all lesions was 4.8 ± 4.1 (range, 0.2-50.1), with the highest values in HCC (6.0 ± 4.7; range, 1.4-21.6), NET (5.4 ± 4.9; range, 0.8-43.0), pancreatic cancer (4.0 ± 2.8; range, 0.9-12.2), and CCC (4.7 ± 2.9; range, 0.9-11.6), and the lowest values in SAR (3.5 ± 1.8; range, 0.8-2.7) and MAM (3.6 ± 2.2; range, 0.9-11.6). The mean TBR mean was 1.9 ± 1.0 (range, 0.1-7.2), with the highest values in NET (2.2 ± 1.2; range, 0.2-7.2), HCC (2.1 ± 1.2; range, 0.3-6.3), and CCC (2.0 ± 1.0; range, 0.2-6.3) and the lowest values in MAM (1.7 ± 0.8; range, 0.2-4.1), CRC (1.8 ± 0.9; range, 0.4-6.6), and SAR (1.7 ± 1.1; range, 0.3-3.9). Conclusion: The 99m Tc-MAA uptake of different tumor entities shows a wide variation, with generally highest values for NET, HCC, and CCC and lowest values for MAM, CRC, and SAR. However, the variation of uptake within the different tumor entities is high.

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“…Although it has been acknowledged that tumor vascularization of colorectal liver metastases is highly abnormal, a considerable heterogenity of the density of small tumor vessels at the liver-to-tumor interface (which represents the target area for 90 Y microspheres) has been reported (28,29). Furthermore, the radiographic vascular appearance of liver metastases does not affect survival after 90 Y radioembolization (30). Regarding the difference between the pattern of 99m Tc-MAA and 90 Y microsphere deposition, several factors have to be addressed.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres

et al. 2013

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90 Y radioembolization is a promising therapy for patients with primary and secondary liver malignancies. Pretherapeutic assessment consists of hepatic angiography and 99m Tc-macroaggregated albumin ( 99m Tc-MAA) perfusion scintigraphy to estimate the liver-to-lung shunt and exclude extrahepatic 99m Tc-MAA deposition. However, the predictive value of intratumoral 99m Tc-MAA uptake remains unclear. Methods: One hundred four patients with chemotherapy-refractory liver-dominant metastatic colorectal cancer were treated with 90 Y radioembolization between December 2006 and December 2010. All of the patients underwent angiographic assessment and perfusion scintigraphy with 99m Tc-MAA before lobar 90 Y radioembolization. For inclusion, patients must have undergone pretherapeutic and follow-up MR imaging (6 wk and 3 mo after radioembolization, respectively). The degree of intratumoral 99m Tc-MAA uptake was rated, and liver metastases were classified according to changes in tumor diameter on both an individual and a patient basis using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Response at both time points, MAA uptake, and catheter position were then statistically analyzed in a linear and generalized linear mixed model at a significance level of 0.05 (P value). Results: Sixty-six patients with a total of 435 colorectal liver metastases (mean number of lesions 6 SD, 6.6 6 2.8; mean lesion size 6 SD, 33.8 6 21.2 mm; lesion size range, 10-154 mm) were included in this analysis. According to the patient-based analysis, 3 patients had partial response, 49 stable disease, and 6 progressive disease after 6 wk. After 3 mo, 5 patients showed partial response, 26 stable disease, and 17 progressive disease. There was no association of patient-based tumor response with overall 99m Tc-MAA uptake (P 5 0.172) or with catheter position (P 5 0.6456). Furthermore, an interaction effect of 99m Tc-MAA uptake and catheter position in relation to tumor response was not found (P 5 0.512). Moreover, in lesion-based analysis according to RECIST 1.1 there was no association of tumor response with degree of 99m Tc-MAA uptake, catheter position, or interaction of 99m Tc-MAA uptake and catheter position (P 5 0.339, 0.593, and 0.658, respectively). Conclusion: Response to 90 Y radioembolization was found to be independent of the degree of 99m Tc-MAA uptake. Therefore, therapy should not be withheld from patients with colorectal liver metastases lacking intratumoral 99m Tc-MAA accumulation. Radi oembolization with 90 Y is a promising catheterbased liver-directed modality approved by the Food and Drug Administration for the treatment of patients with hepatic metastases of colorectal carcinoma (1-4). For this interventional technique, 90 Y-embedded microspheres of glass or resin are infused directly into the hepatic arteries, where they become lodged within the tumor microvasculature and irradiate the tumor by b-emission (5).Perfusion scintigraphy with 99m Tc-labeled macroaggregated albumin ( 99m Tc-MAA) is mandatory before 90 Y radioem...

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The Role of Tumor Vascularity in Predicting Survival after Yttrium-90 Radioembolization for Liver Metastases

Cited by 55 publications

References 15 publications

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

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

Systematic Evaluation of Tumoral ^99mTc-MAA Uptake Using SPECT and SPECT/CT in 502 Patients Before ⁹⁰Y Radioembolization

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres

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The Role of Tumor Vascularity in Predicting Survival after Yttrium-90 Radioembolization for Liver Metastases

Cited by 55 publications

References 15 publications

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

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

Systematic Evaluation of Tumoral 99mTc-MAA Uptake Using SPECT and SPECT/CT in 502 Patients Before 90Y Radioembolization

Predictive Value of Intratumoral 99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with 90Y-Microspheres

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Product

Resources

About

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

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

Systematic Evaluation of Tumoral ^99mTc-MAA Uptake Using SPECT and SPECT/CT in 502 Patients Before ⁹⁰Y Radioembolization

Predictive Value of Intratumoral ^99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with ⁹⁰Y-Microspheres