Medical Devices for Radioembolization
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.
KeywordsYttrium-90 Holmium-166 Rhenium-186/Rhenium-188 Radiolabelled microspheres Radioembolization
- 2.Van de Wiele C, Maes A, Brugman E, D’asseler Y, De Spiegeleer B, Mees G, Stellamans K. SIRT of liver metastases: physiological and pathophysiological considerations. Eur J Nucl Med Mol Imaging. 2012;39:1646–55.Google Scholar
- 4.Nijsen JFW, Zonnenberg BA, Woittiez JRW, Rook DW, Swildens-van Woudenberg IA, van Rijk PP, van het Schip AD. Holmium-166 poly lactic microspheres applicable for intra-arterial radionuclide therapy of hepatic malignancies: effects of preparation and neutron activation techniques. Eur J Nucl Med. 1999;26:699–704.CrossRefPubMedGoogle Scholar
- 9.Van de Maat GH, Seevinck PR, Elschot M, Smits MLJ, de Leeuw H, van het Schip AD, et al. MRI-based biodistribution assessment of holmium-166 poly (L-lactic acid) microspheres after radioembolization. Eur Radiol. 2013;23:827–35.Google Scholar
- 10.Aspasio RD, Borges R, Marchi J. Biocompatible glasses for cancer treatment. In: Marchi J, editor. Biocompatible glasses: from bone regeneration to cancer treatment. Cham: Springer; 2016. p. 267–84.Google Scholar
- 11.Erbe EM, Day DE. Chemical durability of Y2O3-Al2O3-SiO2 glasses for the in vivo delivery of beta radiation. J Biomed Mater Res. 1993;27(10):1301–8.Google Scholar
- 12.Metyko J, Williford JM, Erwin W, Poston J, Jimenez S. Long-lived impurities of 90Y-labeled microspheres, Thera Sphere and SIR-Spheres, and the impact on patients dose and waste management. Radiat Saf J. 2012;103(2):S204–8.Google Scholar
- 13.Day DE, Ehrhardt GJ. Glass microspheres. United States Patent number 4789501. 1988.Google Scholar
- 15.Basciano CA, Kleinstreuer C, Kennedy AS. Computational fluid dynamics modeling of 90Y microspheres in human hepatic tumors. J Nucl Med Radiat Ther. 2011. https://doi.org/10.4172/2155-9619.1000112.
- 17.Caine M, McCafferty MS, McGhee S, Garcia P, Mullett WN, Zhang X, et al. Impact of Yttrium-90 microspheres density, flow dynamics, and administration technique on spatial distribution: analysis using an in vitro model. J Vasc Interv Radiol. 2017;28:260–8.Google Scholar
- 19.Salem R, Mazzaferro V, Sangro B. Yttrium-90 radioembolization for the treatment of hepatocellular carcinoma: biological lesson, current challenges, and clinical perspectives. Hepatology. 2013;58(6):2188–97.Google Scholar
- 20.Gray BN. Polymer based radionuclide containing particulate material. Patent application WO 02/34300 A1. 2002.Google Scholar
- 22.Lambert B, Mertens J, Ravier M, Blanken T, Defreyne L, Van Vlierberghr H, et al. Urinary excretion of Yttrium-90 following intra-arterial microspheres treatment for liver tumours. J Nucl Med. 2011;52(Supplement 1):1744.Google Scholar
- 29.Smits MLJ, Nijsen JFW, van der Bosch MAAJ, Lam MGEH, Vente MAD, Huijbregts JE, et al. Holmium-166 radioembolization for the treatment of patients with liver metastases: design of the phase I HEPAR trial. J Exp Clin Cancer Res. 2010;29:70. http://www.jeccr.com/content/29/1/70 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Zielhuis SW, Nijsen JFW, Krijger GC, van het Schip AD, Hennink WE. Holmium-loaded poly (L-lactic acid) microspheres: in vitro degradation study. Biomacromolecules. 2006;7(7):2217–23.Google Scholar
- 35.Prince JF. Holmium radioembolization: efficacy and safety. PhD thesis. 2016. ISBN 978–90–393-6489-5.Google Scholar
- 38.Elschot M, Nijsen JFW, Lam MGEH, Smits MLJ, Prince JF, Viergever MA, et al. 99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with 166Ho-microspheres. Eur J Nucl Med Mol Imaging. 2014;41:1965–75.Google Scholar
- 44.Nowicki ML, Cwikla JB, Sankowski AJ, Shcherbinin AJ, Grimes J, Celler A, et al. Initial study of radiological and clinical efficacy radioembolization using 188Re-human serum albumin (HSA) microspheres in patients with progressive, unresectable primary or secondary lung cancers. Med Sci Monit. 2014;20:1353–62.Google Scholar