Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors

Kennedy, Andrew S.; McNeillie, Patrick; Dezarn, William A.; Nutting, Charles; Sangro, Bruno; Wertman, Dan; Garafalo, Michael; Liu, David; Coldwell, Douglas M.; Savin, Michael A.; Jakobs, Tobias; Rose, Steven C.; Warner, Richard R.P.; Carter, Dennis; Sapareto, Stephen A.; Nag, Subir; Güleç, Seza A.; Calkins, Alison R.; Gates, Vanessa L.; Salem, Riad

doi:10.1016/j.ijrobp.2008.10.005

Cited by 234 publications

(196 citation statements)

References 47 publications

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“…A U.S. Consensus panel some years ago recommended discontinuation of this method [25], as the high risk of REILD in small livers of early clinical trials using this method was confirmed in a multicenter study [26].…”

Section: Resin Microspheres (Rms)-anmentioning

confidence: 99%

“…Stasis represents the main reason for stopping the delivery of RMS before full planned activity is given due to the high number of spheres (20 million/GBq), and is not desired in part because of shunting into normal liver causing tumour hypoxia [26]. Due to the lower number of GMS typically encountered (400,000/GBq), stasis and embolic effects have yet to be reported [28].…”

Section: Differences Between Rms and Gmsmentioning

confidence: 99%

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A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

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Section: Resin Microspheres (Rms)-anmentioning

confidence: 99%

Section: Differences Between Rms and Gmsmentioning

confidence: 99%

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

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“…Selective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-emitting microspheres is increasingly recognized as an effective therapy of both primary and secondary hepatic malignancies [1][2][3][4][5]. Increasing reports have shown this to be a useful treatment for unresectable hepatic metastases from colorectal carcinoma [6], neuroendocrine tumors [7], and primary hepatocellular carcinoma [3,8,9].…”

Section: Case Reportmentioning

confidence: 99%

“…Gastrointestinal side effects are common, ranging from nausea, epigastric discomfort, vomiting, and anorexia [13] to cholecystitis, hepatitis, and gastroduodenal ulceration [14 -16]. However, the majority of side effects are mild and serious complications are uncommon in appropriately selected patients, with several large series documenting the feasibility of delivering this treatment to a wide variety of patients, including a significant number of elderly patients (Ͼ65 years) and those with an ECOG performance status score Ͼ1 [4,17].…”

Section: Sir-spheres Consist Of Microspheres Containingmentioning

confidence: 99%

“…The two largest series of patients with secondary liver tumors from colorectal or other malignancies reported rates of grade 3 gastrointestinal ulceration of 1%-2% [4,17]. Cases have been reported both with and without the use of prophylactic proton pump inhibitors, with ulcers most commonly occurring in the pylorus, antrum, or duodenum [12,13,16].…”

Section: Sir-spheres Consist Of Microspheres Containingmentioning

confidence: 99%

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A Serious Complication of Selected Internal Radiation Therapy: Case Report and Literature Review

2010

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The use of selective internal radiation therapy (SIRT) with SIR-Spheres (Sirtex, Sydney, Australia) is increasingly recognized as a potential therapeutic modality of primary and secondary malignant liver tumors. A number of treatment-related complications have been described despite technical expertise and detailed pretreatment investigations to assess suitability. We describe a case of gastric ulceration from nontargeted deposition of SIR-spheres in the gastric mucosa with life-threatening consequences. This case highlights the need for careful screening and appropriate patient selection, and the need to recognize ulceration from SIRT as a potential complication of treatment. The characteristic endoscopic, radiologic, and histopathologic findings are illustrated and recommendations are reviewed with regard to the current literature. The Oncologist 2010;15:830 -835 CASE REPORTSelective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-emitting microspheres is increasingly recognized as an effective therapy of both primary and secondary hepatic malignancies [1][2][3][4][5]. Increasing reports have shown this to be a useful treatment for unresectable hepatic metastases from colorectal carcinoma [6], neuroendocrine tumors [7], and primary hepatocellular carcinoma [3,8,9]. A number of treatment-related complications have been described despite technical expertise and detailed pretreatment investigations to assess suitability. We describe a case of gastric ulceration from aberrant deposition of SIR-Spheres (Sirtex, Sydney, Australia) in the gastric mucosa with lifethreatening consequences.The patient, a 63-year-old male with metastatic colorectal cancer, received SIRT 17 weeks earlier at another institution for recurrent, inoperable hepatic metastatic disease. The original diagnosis of rectosigmoid adenocarinoma was made 3 years earlier following an episode of infective endocarditis with Streptococcus viridians.

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AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

Busse,

Al‐Ghazi,

Abi‐Jaoudeh

et al. 2023

J Applied Clin Med Phys

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Radioembolization using Yttrium‐90 (90Y) microspheres is widely used to treat primary and metastatic liver tumors. The present work provides minimum practice guidelines for establishing and supporting such a program. Medical physicists play a key role in patient and staff safety during these procedures. Products currently available are identified and their properties and suppliers summarized. Appropriateness for use is the domain of the treating physician. Patient work up starts with pre‐treatment imaging. First, a mapping study using Technetium‐99m (Tc‐99m) is carried out to quantify the lung shunt fraction (LSF) and to characterize the vascular supply of the liver. An MRI, CT, or a PET‐CT scan is used to obtain information on the tumor burden. The tumor volume, LSF, tumor histology, and other pertinent patient characteristics are used to decide the type and quantity of 90Y to be ordered. On the day of treatment, the appropriate dose is assayed using a dose calibrator with a calibration traceable to a national standard. In the treatment suite, the care team led by an interventional radiologist delivers the dose using real‐time image guidance. The treatment suite is posted as a radioactive area during the procedure and staff wear radiation dosimeters. The treatment room, patient, and staff are surveyed post‐procedure. The dose delivered to the patient is determined from the ratio of pre‐treatment and residual waste exposure rate measurements. Establishing such a treatment modality is a major undertaking requiring an institutional radioactive materials license amendment complying with appropriate federal and state radiation regulations and appropriate staff training commensurate with their respective role and function in the planning and delivery of the procedure. Training, documentation, and areas for potential failure modes are identified and guidance is provided to ameliorate them.

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Treatment Parameters and Outcome in 680 Treatments of Internal Radiation With Resin 90Y-Microspheres for Unresectable Hepatic Tumors

Cited by 234 publications

References 47 publications

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

A Serious Complication of Selected Internal Radiation Therapy: Case Report and Literature Review

AAPM Medical Physics Practice Guideline 14.a: Yttrium‐90 microsphere radioembolization

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