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Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

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Abstract

Introduction

In planning Yttrium-90 (90Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels.

Methods

One hundred 90Y-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography–computerized tomography (SPECT–CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria.

Results

In all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the 90Y-infusion by SPECT–CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature.

Conclusions

All embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.

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Conflict of interest

Carlo Spreafico, Carlo Morosi, Marco Maccauro, Raffaele Romito, Rodolfo Lanocita, Enrico M. Civelli, Carlo Sposito, Sherrie Bhoori, Carlo Chiesa Ph, Laura F. Frigerio, Alice Lorenzoni, Tommaso Cascella, Alfonso Marchianò and Vincenzo Mazzaferro have no conflict of interest

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Authors and Affiliations

  1. Department of Radiology, Fondazione Istituto Tumori, via Venezian 1, 20133, Milan, Italy

    Carlo Spreafico, Carlo Morosi, Rodolfo Lanocita, Enrico M. Civelli, Laura F. Frigerio, Tommaso Cascella & Alfonso Marchianò

  2. Department of Nuclear Medicine, Fondazione Istituto Tumori, via Venezian 1, 20133, Milan, Italy

    Marco Maccauro, Carlo Chiesa & Alice Lorenzoni

  3. Department of Liver Surgery and Transplant, Fondazione Istituto Tumori, via Venezian 1, 20133, Milan, Italy

    Raffaele Romito, Carlo Sposito, Sherrie Bhoori & Vincenzo Mazzaferro

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  1. Carlo Spreafico
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  2. Carlo Morosi
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  3. Marco Maccauro
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  4. Raffaele Romito
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  11. Alice Lorenzoni
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  14. Vincenzo Mazzaferro
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Correspondence to Carlo Spreafico.

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Spreafico, C., Morosi, C., Maccauro, M. et al. Intrahepatic Flow Redistribution in Patients Treated with Radioembolization. Cardiovasc Intervent Radiol 38, 322–328 (2015). https://doi.org/10.1007/s00270-014-0921-2

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  • DOI: https://doi.org/10.1007/s00270-014-0921-2

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