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Girardet R, Knebel JF, Dromain C, Vietti Violi N, Tsoumakidou G, Villard N, Denys A, Halkic N, Demartines N, Kobayashi K, Digklia A, Schaefer N, Prior JO, Boughdad S, Duran R. Anatomical Quantitative Volumetric Evaluation of Liver Segments in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy: Key Parameters Influencing Untreated Liver Hypertrophy. Cancers (Basel) 2024; 16:586. [PMID: 38339337 PMCID: PMC10854872 DOI: 10.3390/cancers16030586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Factors affecting morphological changes in the liver following selective internal radiation therapy (SIRT) are unclear, and the available literature focuses on non-anatomical volumetric assessment techniques in a lobar treatment setting. This study aimed to investigate quantitative changes in the liver post-SIRT using an anatomical volumetric approach in hepatocellular carcinoma (HCC) patients with different levels of treatment selectivity and evaluate the parameters affecting those changes. This retrospective, single-institution, IRB-approved study included 88 HCC patients. Whole liver, liver segments, tumor burden, and spleen volumes were quantified on MRI at baseline and 3/6/12 months post-SIRT using a segmentation-based 3D software relying on liver vascular anatomy. Treatment characteristics, longitudinal clinical/laboratory, and imaging data were analyzed. The Student's t-test and Wilcoxon test evaluated volumetric parameters evolution. Spearman correlation was used to assess the association between variables. Uni/multivariate analyses investigated factors influencing untreated liver volume (uLV) increase. Results: Most patients were cirrhotic (92%) men (86%) with Child-Pugh A (84%). Absolute and relative uLV kept increasing at 3/6/12 months post-SIRT vs. baseline (all, p ≤ 0.005) and was maximal during the first 6 months. Absolute uLV increase was greater in Child-Pugh A5/A6 vs. ≥B7 at 3 months (A5, p = 0.004; A6, p = 0.007) and 6 months (A5, p = 0.072; A6, p = 0.031) vs. baseline. When the Child-Pugh class worsened at 3 or 6 months post-SIRT, uLV did not change significantly, whereas it increased at 3/6/12 months vs. baseline (all p ≤ 0.015) when liver function remained stable. The Child-Pugh score was inversely correlated with absolute and relative uLV increase at 3 months (rho = -0.21, p = 0.047; rho = -0.229, p = 0.048). In multivariate analysis, uLV increase was influenced at 3 months by younger age (p = 0.013), administered 90Y activity (p = 0.003), and baseline spleen volume (p = 0.023). At 6 months, uLV increase was impacted by younger age (p = 0.006), whereas treatment with glass microspheres (vs. resin) demonstrated a clear trend towards better hypertrophy (f = 3.833, p = 0.058). The amount (percentage) of treated liver strongly impacted the relative uLV increase at 3/6/12 months (all f ≥ 8.407, p ≤ 0.01). Conclusion: Liver function (preserved baseline and stable post-SIRT) favored uLV hypertrophy. Younger patients, smaller baseline spleen volume, higher administered 90Y activity, and a larger amount of treated liver were associated with a higher degree of untreated liver hypertrophy. These factors should be considered in surgical candidates undergoing neoadjuvant SIRT.
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Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Jean-François Knebel
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Clarisse Dromain
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Naik Vietti Violi
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Nicolas Villard
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
| | - Kosuke Kobayashi
- Department of Visceral Surgery, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.H.); (N.D.); (K.K.)
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland;
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (N.S.); (J.O.P.); (S.B.)
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, 1011 Lausanne, Switzerland; (R.G.); (J.-F.K.); (C.D.); (N.V.V.); (G.T.); (N.V.); (A.D.)
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Liu C, Tadros G, Smith Q, Martinez L, Jeffries J, Yu Z, Yu Q. Selective internal radiation therapy of metastatic breast cancer to the liver: A meta-analysis. Front Oncol 2022; 12:887653. [PMID: 36505832 PMCID: PMC9729947 DOI: 10.3389/fonc.2022.887653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The aim of this study is to conduct a meta-analysis to assess the efficacy of yttrium-90 selective internal radiation therapy (SIRT) in treating patients with breast cancer with hepatic metastasis. Method PubMed and The Cochrane Library were queried from establishment to January 2021. The following keywords were implemented: "breast", "yttrium", and "radioembolization". The following variables and outcomes were collected: publication year, region, sample size, study design, presence of extrahepatic disease, tumor burden, infused radioactivity, breast cancer subtype, previous treatment, median survival time (MST), length of follow-up, adverse events, and radiographical response such as Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). Results A total of 24 studies from 14 institutions were included in the present meta-analysis. On the basis of the data from 412 patients, post-embolization MST was 9.8 [95% confidence interval (CI): 9.0-11.6] months. Patients with additional extrahepatic metastasis had a poorer survival rate compared with those with localized hepatic metastasis only (MST: 5.3 vs. 15 months, p < 0.0001). Patients with <25% liver tumor burden exhibited more promising survival than those with >25% (MST: 10.5 vs. 6.8 months, p < 0.0139). On the basis of RECIST, mRECIST, and PERCIST criteria, tumor response rate was 36% (95% CI: 26%-47%), 49% (95% CI: 34%-65%), and 47% (95% CI: 17%-78%), respectively, whereas tumor control rate was 85% (95% CI: 76%-93%), 73% (95% CI: 59%-85%), and 97% (95% CI: 91%-100%), respectively. Conclusion On the basis of the available published evidence, SIRT is feasible and effective in treating patients with breast cancer with liver metastasis. Patients with lower hepatic tumor burden and without extrahepatic metastasis demonstrated more survival benefit. Future randomized controlled trials are warranted.
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Affiliation(s)
- Chenyu Liu
- School of Medicine, George Washington University, Washington DC, United States
| | - George Tadros
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, United States
| | - Quinn Smith
- Kansas City University, College of Osteopathic Medicine, Kansas City, MO, United States
| | - Linda Martinez
- School of Medicine, Ross University, Miramar, FL, United States
| | - James Jeffries
- Interventional Radiology, University of Chicago, Chicago, IL, United States
| | - Zhiyong Yu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Yu
- Interventional Radiology, University of Chicago, Chicago, IL, United States,*Correspondence: Qian Yu,
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Seidensticker M, Fabritius MP, Beller J, Seidensticker R, Todica A, Ilhan H, Pech M, Heinze C, Powerski M, Damm R, Weiss A, Rueckel J, Omari J, Amthauer H, Ricke J. Impact of Pharmaceutical Prophylaxis on Radiation-Induced Liver Disease Following Radioembolization. Cancers (Basel) 2021; 13:cancers13091992. [PMID: 33919073 PMCID: PMC8122451 DOI: 10.3390/cancers13091992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Radioembolization has failed to prove survival benefit in randomized trials, and, depending on various factors including tumor biology, response rates may vary considerably. Studies showed positive correlations between survival and absorbed tumor dose. Therefore, increasing currently prescribed tumor doses may be favorable for improving patient outcomes. The dominant limiting factor for increasing RE dose prescriptions is the relatively low tolerance of liver parenchyma to radiation with the possible consequence of a radiation-induced liver disease. Advances in RILD prevention may help increasing tolerable radiation doses to improve patient outcomes. Our study aimed to evaluate the impact of post-therapeutic RILD-prophylaxis in a cohort of intensely pretreated liver metastatic breast cancer patients. The results of this study as well as pathophysiological considerations warrant further investigations of RILD prophylaxis to increase dose prescriptions in radioembolization. Abstract Background: Radioembolization (RE) with yttrium-90 (90Y) resin microspheres yields heterogeneous response rates in with primary or secondary liver cancer. Radiation-induced liver disease (RILD) is a potentially life-threatening complication with higher prevalence in cirrhotics or patients exposed to previous chemotherapies. Advances in RILD prevention may help increasing tolerable radiation doses to improve patient outcomes. This study aimed to evaluate the impact of post-therapeutic RILD-prophylaxis in a cohort of intensely pretreated liver metastatic breast cancer patients; Methods: Ninety-three patients with liver metastases of breast cancer received RE between 2007 and 2016. All Patients received RILD prophylaxis for 8 weeks post-RE. From January 2014, RILD prophylaxis was changed from ursodeoxycholic acid (UDCA) and prednisolone (standard prophylaxis [SP]; n = 59) to pentoxifylline (PTX), UDCA and low-dose low molecular weight heparin (LMWH) (modified prophylaxis (MP); n = 34). The primary endpoint was toxicity including symptoms of RILD; Results: Dose exposure of normal liver parenchyma was higher in the modified vs. standard prophylaxis group (47.2 Gy (17.8–86.8) vs. 40.2 Gy (12.5–83.5), p = 0.017). All grade RILD events (mild: bilirubin ≥ 21 µmol/L (but <30 μmol/L); severe: (bilirubin ≥ 30 µmol/L and ascites)) were observed more frequently in the SP group than in the MP group, albeit without significance (7/59 vs. 1/34; p = 0.140). Severe RILD occurred in the SP group only (n = 2; p > 0.1). ALBI grade increased in 16.7% patients in the MP and in 27.1% patients in the SP group, respectively (group difference not significant); Conclusions: At established dose levels, mild or severe RILD events proved rare in our cohort. RILD prophylaxis with PTX, UDCA and LMWH appears to have an independent positive impact on OS in patients with metastatic breast cancer and may reduce the frequency and severity of RILD. Results of this study as well as pathophysiological considerations warrant further investigations of RILD prophylaxis presumably targeting combinations of anticoagulation (MP) and antiinflammation (SP) to increase dose prescriptions in radioembolization.
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Affiliation(s)
- Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (J.R.); (J.R.)
- Correspondence: (M.S.); (M.P.F.)
| | - Matthias Philipp Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (J.R.); (J.R.)
- Correspondence: (M.S.); (M.P.F.)
| | - Jannik Beller
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Ricarda Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (J.R.); (J.R.)
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (A.T.); (H.I.)
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (A.T.); (H.I.)
| | - Maciej Pech
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Constanze Heinze
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Maciej Powerski
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Robert Damm
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Alexander Weiss
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Johannes Rueckel
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (J.R.); (J.R.)
| | - Jazan Omari
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universitätsklinikum, 39120 Magdeburg, Germany; (J.B.); (M.P.); (C.H.); (M.P.); (R.D.); (A.W.); (J.O.)
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (R.S.); (J.R.); (J.R.)
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Coretti S, Rumi F, Sacchini D, Cicchetti A. SIR-Spheres ® Y-90 resin microspheres in chemotherapy refractory or intolerant patients with metastatic colorectal cancer. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319847446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Selective internal radiation therapy is a form of intra-arterial brachytherapy used to treat primary liver cancer and liver metastases. This article aims to provide an overview of the clinical, economic, organizational legal, social and ethical impact of selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres in the treatment of patients with unresectable, liver-dominant metastatic colorectal cancer who are refractory to or intolerant of chemotherapy. A systematic literature review was performed by querying PubMed, Scopus, EBSCO, CRD and GIN. Two reviewers blindly screened the records retrieved against predefined inclusion/exclusion criteria. The selected studies where summarized following a simplified version of the EuNetHTA Core Model® 2.1. The studies included evaluated selective internal radiation therapy in first-line or further-line treatment and showed a good safety and tolerability profile and significant improvement in efficacy expressed as time to liver progression, progression-free survival and overall survival. Selective internal radiation therapy should be provided in specialized centres and administered by a multidisciplinary team. A hub-and-spoke network could be a viable option to guarantee access to this technology across jurisdictions. The lack of a specific diagnosis-related group tariff accounting for the cost of the device could be seen as the major obstacle to a fair diffusion of this technology. The economic evaluations currently available show the cost-effectiveness of this technology in the population under study. Selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres appears to be a clinically effective and cost-effective option in the treatment of metastatic colorectal cancer patients who are chemotherapy refractory or chemotherapy intolerant.
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Affiliation(s)
- Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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Sangro B, Martínez-Urbistondo D, Bester L, Bilbao JI, Coldwell DM, Flamen P, Kennedy A, Ricke J, Sharma RA. Prevention and treatment of complications of selective internal radiation therapy: Expert guidance and systematic review. Hepatology 2017; 66:969-982. [PMID: 28407278 DOI: 10.1002/hep.29207] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/02/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023]
Abstract
Selective internal radiation therapy (or radioembolization) by intra-arterial injection of radioactive yttrium-90-loaded microspheres is increasingly used for the treatment of patients with liver metastases or primary liver cancer. The high-dose beta-radiation penetrates an average of only 2.5 mm from the source, thus limiting its effects to the site of delivery. However, the off-target diversion of yttrium-90 microspheres to tissues other than the tumor may lead to complications. The most prominent of these complications include radiation gastritis and gastrointestinal ulcers, cholecystitis, radiation pneumonitis, and radioembolization-induced liver disease, which may occur despite careful pretreatment planning. Thus, selective internal radiation therapy demands an expert multidisciplinary team approach in order to provide comprehensive care for patients. This review provides recommendations to multidisciplinary teams on the optimal medical processes in order to ensure the safe delivery of selective internal radiation therapy. Based on the best available published evidence and expert opinion, we recommend the most appropriate strategies for the prevention, early diagnosis, and management of potential radiation injury to the liver and to other organs. (Hepatology 2017;66:969-982).
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Affiliation(s)
- Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Pamplona, Spain
| | - Diego Martínez-Urbistondo
- Liver Unit, Clinica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Lourens Bester
- Department of Interventional Radiology, University of New South Wales St. Vincent's Hospital, Darlinghurst, Australia
| | - Jose I Bilbao
- Department of Radiology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Douglas M Coldwell
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Patrick Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Brussels, Belgium
| | - Andrew Kennedy
- Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Ricky A Sharma
- University College London, UCL Cancer Institute, London, UK
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Paprottka PM, Paprottka KJ, Walter A, Haug AR, Trumm CG, Lehner S, Fendler WP, Jakobs TF, Reiser MF, Zech CJ. Safety of Radioembolization with (90)Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels. Cardiovasc Intervent Radiol 2015; 38:946-56. [PMID: 25986465 DOI: 10.1007/s00270-015-1128-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/01/2015] [Indexed: 12/27/2022]
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 METHODS Early 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 (≥ Grade 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.
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Affiliation(s)
- P M Paprottka
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistr. 15, 81377, Munich, Germany,
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Spleen: promised land for new and novel interventions? Cardiovasc Intervent Radiol 2014; 38:501-2. [PMID: 25424043 DOI: 10.1007/s00270-014-1029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
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Theysohn JM, Ertle J, Müller S, Schlaak JF, Nensa F, Sipilae S, Bockisch A, Lauenstein TC. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol 2013; 69:172-8. [PMID: 24209871 DOI: 10.1016/j.crad.2013.09.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/16/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
AIM To assess volume changes of treated and non-treated liver segments after selective internal radiation therapy (SIRT) in patients with hepatocellular carcinoma (HCC) and compromised hepatic function due to cirrhosis over a time course of 12 months after SIRT. MATERIALS AND METHODS All patients underwent SIRT of the right liver lobe with yttrium 90 (Y-90). Absolute volumes of the right liver lobe (RLV) and left liver lobe (LLV) were assessed using computed tomography (CT) before and 1, 3, 6, 9, and 12 months after SIRT. Changes at follow-up relative to baseline volumes were analysed ("normalized" volumes). Furthermore, the relative volume of the LLV [LLV/(RLV + LLV)] was calculated ("relative" volumes). For statistical analysis p < 0.05 was considered statistically significant. RESULTS Forty-five HCC patients (36 men, nine women, mean age 71.9 years, range 55-90 years) were studied. The mean baseline RLV and LLV reached 1116 ml [95% confidence intervals (CI): 1006-1226 ml] and 601 ml (95% CI: 514-688 ml), respectively. At 6 months following radioembolization, the LLV increased by 30.8% (RLV -33.9%), with the relative LLV increasing from 35% (pre-radioembolization) to 50.5%. RLV further decreased and LLV increased 12 months after SIRT (nRLV -44.9%, nLLV +40.1%, relative LLV 56.5%). All changes were significant. CONCLUSION Constraints of liver function after radioembolization of one liver lobe can be partially compensated through hypertrophy of the contralateral lobe. The rate of volumetric changes is the highest in the first 6 months following radioembolization. The present data can also be the basis to propagate radiation lobectomy for selected patients, simultaneously providing tumour control and future remnant liver hypertrophy before curative hemihepatectomy.
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Affiliation(s)
- J M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - J Ertle
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - S Müller
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - J F Schlaak
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - F Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - S Sipilae
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - A Bockisch
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - T C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Lam MGEH, Banerjee A, Louie JD, Sze DY. Splenomegaly-associated thrombocytopenia after hepatic yttrium-90 radioembolization. Cardiovasc Intervent Radiol 2013; 37:1009-17. [PMID: 24091754 DOI: 10.1007/s00270-013-0742-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/28/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE Thrombocytopenia is often observed after yttrium-90 radioembolization (RE). Possible mechanisms include radiation toxicity to the bone marrow, consumption in the liver due to local radiation effects, and sequestration in the spleen. We sought to identify the causative factors. MATERIALS AND METHODS Patients with complete baseline and 3-month post-RE imaging and laboratory data were included in this retrospective analysis. Univariate and multivariate regression analyses were performed on clinical, procedural, and imaging data. RESULTS A total of 116 patients were identified (65 male, 51 female; median age 64 years). Forty-six patients were treated for primary and 70 for metastatic liver malignancy. Of these, 86 were treated with resin and 30 with glass microspheres; median activity was 1.85 GBq. Eighty-three patients underwent whole-liver treatment. Maximum individual change in platelet count was -20.2 % leading to new or increased grade of thrombocytopenia in 48 patients (41.4 %) by National Cancer Institute Common Toxicity Criteria for Adverse Events version 4.02 criteria. Independent risk factors for decreased platelet count included change in spleen volume (median change +17.5 %; p = 0.001) and whole-liver (rather than lobar or segmental) treatment (p = 0.025). Administered activity and absorbed dose were not associated with change in platelet count. The change in spleen volume itself was associated with previous epidermal growth factor receptor-inhibitor treatment (p = 0.002), whole-liver absorbed dose (p = 0.027), and multiple-line chemotherapy (0.012) for whole-liver treatments only. CONCLUSION Post-RE treatment increase of spleen volume is correlated with decreased peripheral platelet count suggesting a mechanism of increased portal hypertension and hypersplenism being responsible.
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Affiliation(s)
- Marnix G E H Lam
- Division of Interventional Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5642, USA,
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Current world literature. Curr Opin Oncol 2012; 24:756-68. [PMID: 23079785 DOI: 10.1097/cco.0b013e32835a4c91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hepatic volume changes induced by radioembolization with 90Y resin microspheres. A single-centre study. Eur J Nucl Med Mol Imaging 2012; 40:80-90. [DOI: 10.1007/s00259-012-2253-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/12/2012] [Indexed: 12/11/2022]
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Changes in spleen volume after resection of hepatic colorectal metastases. Clin Radiol 2012; 67:982-7. [PMID: 22608244 DOI: 10.1016/j.crad.2012.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 02/07/2023]
Abstract
AIM To identify and describe changes in spleen volume occurring in patients with colorectal metastases to the liver after partial hepatectomy. MATERIALS AND METHODS Forty-one consecutive patients (20 men, 21 women) with histopathology-proven colorectal liver metastases who underwent partial hepatectomy between August 2007 and April 2011 were included. Liver and spleen volumes were measured by computed tomography (CT) volumetry on the most recent CT prior to surgery and on all CTs obtained within a year after partial hepatectomy. Patients were carefully evaluated for and excluded if they had co-morbid conditions known to cause splenomegaly or risk factors for portal hypertension such as underlying liver disease and portal vein thrombosis. RESULTS Thirty-two (78%) patients demonstrated an increase in spleen volume on the first post-operative CT, with more than a double increase in volume amongst five patients. Spleen volume increased by an average of 43% within 3 months of partial hepatectomy (p < 0.0001) and remained increased through 6 months after surgery, returning to near baseline thereafter. In the remaining nine (22%) patients, the spleen was observed to decrease an average of 11% in volume on first postoperative CT (p < 0.005). CONCLUSIONS Splenic enlargement after partial hepatectomy of colorectal metastases is a common finding on CT. Increased familiarity amongst radiologists of this phenomenon as likely reflecting physiological changes is important in order to avoid unnecessary evaluation for underlying conditions causing interval enlargement of the spleen.
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Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients. Cardiovasc Intervent Radiol 2012; 36:158-65. [PMID: 22526099 DOI: 10.1007/s00270-012-0373-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To retrospectively evaluate the overall survival, safety, and efficacy of metastatic uveal melanoma patients after radioembolization as salvage therapy. MATERIALS AND METHODS Thirteen patients were treated with radioembolization of branches of the hepatic artery with resin-based yttrium-90 ((90)Y)-labelled microspheres. Twelve patients underwent a single application, and 1 patient underwent 4 interventions. Dosages from 644 to 2,450 MBq (mean activity 1,780) were applied. Treatment response was evaluated by way of liver magnetic resonance imaging and computed tomography (CT) as well as whole-body fluorodeoxyglucose positron emission tomography (PET)/CT with evaluation of percentage changes in SUV(max) before and at 2-3 months after therapy. Kaplan-Meier analysis was calculated to determine overall survival. RESULTS Partial remission (PR) was observed in 8 (62 %), stable disease (SD) in 2 (15 %), and progressive disease (PD) in 3 (23 %) patients under terms of standard criteria and PR in 3 (23 %), SD in 3 (23 %), and PD in 7 (54 %) patients according to PET criteria. Neither RECIST nor PET criteria showed a significant difference in predicting overall survival (P = 0.12 and 0.11, respectively). Median survival time after radioembolization was 7 months. No acute toxicity with in-hospital morbidity was observed. One patient developed hepatomegaly, and 1 patient developed gastric ulceration. Throughout follow-up, progression of extrahepatic metastases was observed. CONCLUSION Radioembolization may be a promising therapy in uveal melanoma patients with predominant hepatic metastases. At first follow-up, we observed PR or SD in 77 % patients under terms of standard criteria with an acceptable toxicity profile.
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