Abstract
Transarterial radioembolization with yttrium-90 (90Y) microspheres is an intra-arterial brachytherapy approved for the treatment of hepatocellular carcinoma and metastatic colorectal cancer. 90Y is a pure beta particle-emitting radionuclide with a 64.1 hours physical half-life and a maximum energy of 2.27 MeV. Selective hepatic arterial infusion allows preferential treatment of tumor cells while limiting damage to normal liver parenchyma. Glass microspheres and resin microspheres with high specific activities of 90Y are commercially available for radioembolization. Dosimetry refers to the process of calculating and prescribing the activity of 90Y to administer to a specific patient to result in a tumoricidal dose while maintaining a safe dose to the liver and lung parenchyma. The 90Y treatment plan requires an initial angiographic procedure to map the hepatic arterial anatomy, eliminate potential routes of nontarget embolization, and administer a simulation dose of 99mTc-macroaggregated albumin (99mTc-MAA) to calculate the lung shunt fraction and delineate intrahepatic distribution, and a second procedure to administer the therapeutic 90Y dose.
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References
Kan Z, Madoff DC. Liver anatomy: microcirculation of the liver. Semin Interv Radiol. 2008;25(2):77–85.
O’Rourke JM, Sagar VM, Shah T, Shetty S. Carcinogenesis on the background of liver fibrosis: implications for the management of hepatocellular carcinoma. World J Gastroenterol. 2018;24(39):4436–47.
Tajima T, Honda H, Taguchi K, et al. Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. AJR Am J Roentgenol. 2002;178(4):885–97.
Anderson JH, Angerson WJ, Willmott N, Kerr DJ, McArdle CS, Cooke TG. Regional delivery of microspheres to liver metastases: the effects of particle size and concentration on intrahepatic distribution. Br J Cancer. 1991;64(6):1031–4.
Atassi B, Bangash AK, Lewandowski RJ, et al. Biliary sequela following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol. 2008;19:691–7.
Murthy R, Kamat P, Nunez R, Salem R. Radioembolization of yttrium-90 microspheres for hepatic malignancy. Semin Interv Radiol. 2008;25(1):48–57.
Lee EW, Alanis L, Cho SK, Saab S. Yttrium-90 selective internal radiation therapy with glass microspheres for hepatocellular carcinoma: current and updated literature review. Korean J Radiol. 2016;17(4):472–88.
Tong AK, Kao YH, Too CW, Chin KF, Ng DC, Chow PK. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. Br J Radiol. 2016;89(1062):20150943.
Salem R, Thurston KG. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol. 2006;17(8):1251–78.
Salem R, Padia SA, Lam M, et al. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nuc Med Mol Imag. 2019;46(8):1695–704.
Riaz A, Lewandowski RJ, Kulik LM, et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol. 2009;20(9):1121–30.
Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: special topics. J Vasc Interv Radiol. 2006;17(9):1425–39.
Kao YH, Magsombol BM, Toh Y, et al. Personalized predictive lung dosimetry by technetium-99m macroaggregated albumin SPECT/CT for yttrium-90 radioembolization. EJNMMI Res. 2014;4(33):1–12.
Braat MN, van Erpecum KJ, Zonnenberg BA, van den Bosch MA, Lam MG. Radioembolization-induced liver disease: a systematic review. Eur J Gastroenterol Hepatol. 2017;29(2):144–52.
Saini A, Wallace A, Alzubaidi S, et al. History and evolution of yttrium-90 radioembolization for hepatocellular carcinoma. J Clin Med. 2019;8(1):E55.
Doherty JO. A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy. J Diagn Imag Thr. 2015;2(2):1–34.
Conflicts of Interest and Financial disclosures
DYS is a consultant for Boston Scientific/BTG/Nordion, SIR-Tex, and Terumo/Quirem, and has received institutional research support from Boston Scientific/BTG/Nordion and SIR-Tex.
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Picel, A.C., Sze, D.Y. (2020). Physics and Physiology of 90Y Radioembolization for Liver Tumors. In: Georgiades, C., Kim, H. (eds) Image-Guided Interventions in Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-48767-6_2
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