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Medical Devices for Radioembolization

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Clinical Applications of Nuclear Medicine Targeted Therapy

Abstract

Microspheres of the proper size injected into the hepatic artery lodge themselves preferentially in and around tumours as a result of both the increased vascularity of tumours and the fact that blood from the hepatic artery flows preferentially to malignancies. Thus, radioembolization with microspheres labelled with β−-emitter radionuclides has become a well-established and powerful tool for the treatment of liver malignancies, since it adds to the embolization effect the deposition of lethal doses of radiation to the tumour cells.

Two commercially available medical devices of this type labelled with yttrium-90 (90Y) are presently authorized for human use. Although both are reportedly effective, they have key dissimilarities strictly related to their chemical form and manufacturing method. The aim of this chapter is to examine these factors in terms of pro and cons and how they can affect the use and biodistribution of radiolabelled microspheres.

Last, the need to have good in vivo imaging during pretreatment procedure, as well as during and/or after administration of the dose, has encouraged to explore alternative radionuclides to 90Y able to fulfil this requirement, such as holmium-166 (166Ho) and rhenium-186 and rhenium-188 (186Re/188Re). These, together with the development of different microsphere matrixes, will be also discussed.

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Notes

  1. 1.

    As it is often the case with products covered by patent, detailed and clear information is not always available. Where this was missing, second-hand data available from literature was used.

  2. 2.

    Microsphere distribution after treatment commonly exploits the bremsstrahlung radiation produced by the decelerating β−. Unfortunately, 90Y-bremsstrahlung post-therapy imaging is not optimal for precise evaluation and dose calculation of radioactive sphere deposition within tumour lesion. However, since 90Y decay is accompanied also by a 0.003% positron emission, the recent development of highly sensitive tomographs has made feasible the imaging also by positron emission tomography (PET).

  3. 3.

    A support to this opinion is the fact that, as pointed out later in the text, the use of saline should be avoided since it could release 90Y by a cation-exchange process, something that should be irrelevant in case of yttrium phosphate.

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Authors and Affiliations

  1. Fondazione IRCCS “Istituto dei Tumori”, Nuclear Medicine Unit, Milan, Italy

    Anna Bogni & Claudio Pascali

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  1. Anna Bogni
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  2. Claudio Pascali
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Correspondence to Anna Bogni .

Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine, Humanitas Gavazzeni Hospital, Bergamo, Italy

    Emilio Bombardieri

  2. Nuclear Medicine Therapy and Endocrinology, Istituto Nazionale dei Tumori, Milano, Italy

    Ettore Seregni

  3. Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy

    Laura Evangelista

  4. Nuclear Medicine Division, Istituto Nazionale dei Tumori, Milano, Italy

    Carlo Chiesa

  5. Nuclear Medicine, Humanitas Research Hospital, Rozzano, Milano, Italy

    Arturo Chiti

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Bogni, A., Pascali, C. (2018). Medical Devices for Radioembolization. In: Bombardieri, E., Seregni, E., Evangelista, L., Chiesa, C., Chiti, A. (eds) Clinical Applications of Nuclear Medicine Targeted Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-63067-0_10

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  • DOI: https://doi.org/10.1007/978-3-319-63067-0_10

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