Abstract
Purpose
Quantification of post-interventional adverse events of outpatient SIRT leading to hospitalization and quantification of radiation exposure.
Materials and methods
In this single-center, retrospective cohort study, we reviewed 212 patients treated with SIRT (90Y-microspheres) for primary and secondary liver malignancies. We searched for adverse events (AEs) and serious adverse events (SAEs), defined as AE’s causing hospitalization. Additionally, radiation exposure was measured in 36 patients.
Results
Seven patients had an SAE (3.3%), four patients had AE without readmission/hospitalization (1.9%) and 201 patients had no complications (94.8%). The mean ambient dose rate at 1 m distance from the source after administration of 90Y-microspheres was 1.88 µSv/h ± 0.74 (± SD) with a range from 4.3 to 0.2 µSv/h.
Conclusion
Outpatient radioembolization with 90Y-microspheres is safe and requires hospitalization only in a very small number of patients. The mean dose rate was low and met the national conditions for outpatient treatment (< 5 µSv/h).
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Abbreviations
- 99mTc-MAA:
-
Technetium-99m-labeled macroaggregated albumin
- AE:
-
Adverse event
- BCLC:
-
Barcelona clinic liver cancer
- BSA:
-
Body surface area
- SIRT:
-
Selective internal radiation therapy
- CCC:
-
Cholangiocarcinoma
- CI:
-
Confidence interval
- CUP:
-
Cancer of unknown primary
- DSA:
-
Digital subtraction arteriograms
- eGFR:
-
Estimated glomerular filtration rate
- HCC:
-
Hepatocellular carcinoma
- NET:
-
Neuroendocrine tumor
- RCC:
-
Renal cell carcinoma
- SD:
-
Standard deviation
- SPECT:
-
Single-photon emission computed tomography
- TACE:
-
Transarterial chemoembolization
References
Gulec SA, Fong Y (2007) Yttrium 90 microsphere selective internal radiation treatment of hepatic colorectal metastases. Arch Surg 142(7):675–682
Ali R, Riaz A, Gabr A et al (2017) Clinical outcomes of Y90 radioembolization for recurrent hepatocellular carcinoma following curative resection. Eur J Nucl Med Mol Imaging 44(13):2195–2202
Salem R, Lewandowski RJ, Mulcahy MF et al (2010) Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 138(1):52–64
Weber SM, Ribero D, O’Reilly EM, Kokudo N, Miyazaki M, Pawlik TM (2015) Intrahepatic cholangiocarcinoma: expert consensus statement. HPB 17(8):669–680
Eldredge-Hindy H, Ohri N, Anne PR et al (2016) Yttrium-90 microsphere brachytherapy for liver metastases from uveal melanoma: clinical outcomes and the predictive value of fluorodeoxyglucose positron emission tomography. Am J Clin Oncol 39(2):189–195
Klingenstein A, Haug AR, Zech CJ, Schaller UC (2013) Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients. Cardiovasc Interv Radiol 36(1):158–165
Gordon AC, Salem R, Lewandowski RJ (2016) Yttrium-90 radioembolization for breast cancer liver metastases. J Vasc Interv Radiol 27(9):1316–1319
Pieper CC, Meyer C, Wilhelm KE et al (2016) Yttrium-90 radioembolization of advanced, unresectable breast cancer liver metastases—a single-center experience. J Vasc Interv Radiol 27(9):1305–1315
Vyleta M, Coldwell D (2011) Radioembolization in the treatment of neuroendocrine tumor metastases to the liver. Int J Hepatol 2011:785315
Do Minh D, Chapiro J, Gorodetski B et al (2017) Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and Yttrium-90 radioembolisation as treatment options using a propensity score analysis model. Eur Radiol 27(12):4995–5005
Kis B, Shah J, Choi J et al (2017) Transarterial Yttrium-90 radioembolization treatment of patients with liver-dominant metastatic renal cell carcinoma. J Vasc Interv Radiol 28(2):254–259
Kim AY, Unger K, Wang H, Pishvaian MJ (2016) Incorporating Yttrium-90 trans-arterial radioembolization (TARE) in the treatment of metastatic pancreatic adenocarcioma: a single center experience. BMC Cancer 16:492
Pöpperl G, Helmberger T, Münzing W, Schmid R, Jacobs TF, Tatsch K (2005) Selective internal radiation therapy with SIR-spheres® in patients with nonresectable liver tumors. Cancer Biother Radiopharm 20(2):200–208
Jakobs TF, Hoffmann R-T, Poepperl G et al (2006) Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using 90Yttrium resin-microspheres. Eur Radiol 17(5):1320
Mancini R, Carpanese L, Sciuto R et al (2006) A multicentric phase II clinical trial on intra-arterial hepatic radiotherapy with 90Yttrium SIR-spheres in unresectable, colorectal liver metastases refractory to iv chemotherapy: preliminary results on toxicity and response rates. In Vivo 20(6A):711–714
Andrews JC, Walker SC, Ackermann RJ, Cotton LA, Ensminger WD, Shapiro B (1994) Hepatic radioembolization with Yttrium-90 containing glass microspheres: preliminary results and clinical follow-up. J Nucl Med 35(10):1637–1644
Sato K, Lewandowski RJ, Bui JT et al (2006) Treatment of unresectable primary and metastatic liver cancer with Yttrium-90 microspheres (TheraSphere®): assessment of hepatic arterial embolization. Cardiovasc Interv Radiol 29(4):522–529
Ogawa F, Mino-Kenudson M, Shimizu M, Ligato S, Lauwers GY (2008) Gastroduodenitis associated with Yttrium 90—microsphere selective internal radiation: an iatrogenic complication in need of recognition. Arch Pathol Lab Med 132(11):1734–1738
Crowder CD, Grabowski C, Inampudi S, Sielaff T, Sherman CA, Batts KP (2009) Selective internal radiation therapy-induced extrahepatic injury: an emerging cause of iatrogenic organ damage. Am J Surg Pathol 33(7):963–975
Stubbs RS, O’Brien I, Correia MM (2006) Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients. ANZ J Surg 76(8):696–703
Grady ED (1979) Internal radiation therapy of hepatic cancer. Dis Colon Rectum 22(6):371–375
Leung TWT, Lau W-Y, Ho SKW et al (1995) Radiation pneumonitis after selective internal radiation treatment with intraarterial 90Yttrium-microspheres for inoperable hepatic tumors. Int J Radiat Oncol Biol Phys 33(4):919–924
Lee EW, Alanis L, Cho S-K, Saab S (2016) Yttrium-90 selective internal radiation therapy with glass microspheres for hepatocellular carcinoma: current and updated literature review. Korean J Radiol 17(4):472–488
Gates VL, Marshall KG, Salzig K, Williams M, Lewandowski RJ, Salem R (2014) Outpatient single-session Yttrium-90 glass microsphere radioembolization. J Vasc Interv Radiol 25(2):266–270
Giammarile F, Bodei L, Chiesa C et al (2011) EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 38(7):1393
Limited SM. SIR-spheres Y-90 resin microspheres (Yttrium-90 microspheres); Appendix III: calculation of individual dose, Jan 2017, p 3
Eng J (2003) Sample size estimation: how many individuals should be studied? Radiology 227(2):309–313
Gesundheit Bf (2018) https://www.bag.admin.ch
Abdel-Wahab M, Rosenblatt E, Holmberg O, Meghzifene A (2011) Safety in radiation oncology: the role of international initiatives by the International Atomic Energy Agency. J Am Coll Radiol 8(11):789–794
Dancey JE, Shepherd FA, Paul K et al (2000) Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med 41(10):1673–1681
Rennert J, Mrosek S, Stroszczynski C, Schöffski O, Schreyer A (2017) Analyse von Kosten und Erlösen der 10 häufigsten angiografischen Interventionen bei einem Krankenhaus der Maximalversorgung. Gesundheitswesen 79(10):e85–e94
Blackburn H, West S (2016) Management of postembolization syndrome following hepatic transarterial chemoembolization for primary or metastatic liver cancer. Cancer Nurs 39(5):E1–E18
Fritsche MR, Watchmaker JM, Lipnik AJ et al (2018) Outpatient transarterial chemoembolization of hepatocellular carcinoma: review of a same-day discharge strategy. J Vasc Interv Radiol 29(4):550–555
Murakami T, Tsurusaki M (2014) Hypervascular benign and malignant liver tumors that require differentiation from hepatocellular carcinoma: key points of imaging diagnosis. Liver Cancer 3(2):85–96
Kleine MDJW, Khouw MDYH, Heeres MDMG (1978) Hypovolemia and hypotension with carcinoid syndrome. Anesthesiology 49(1):55
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Aberle, S., Kenkel, D., Becker, A.S. et al. Outpatient Yttrium-90 microsphere radioembolization: assessment of radiation safety and quantification of post-treatment adverse events causing hospitalization. Radiol med 125, 971–980 (2020). https://doi.org/10.1007/s11547-020-01180-4
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DOI: https://doi.org/10.1007/s11547-020-01180-4