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Title: Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres

Abstract

Purpose. Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations .Methods. In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results. RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion. RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, withmore » similar technical success, by both anterograde and retrograde approaches.« less

Authors:
;  [1];  [2]; ; ;  [3]
  1. Clinica Universitaria de Navarra, Departamento de Radiologia (Spain), E-mail: jibilbao@unav.es
  2. Hospital Pablo Tobon Uribe, Servicio de Radiologia (Colombia)
  3. Clinica Universitaria de Navarra, Departamento de Radiologia (Spain)
Publication Date:
OSTI Identifier:
21091053
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-006-0028-5; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; EVALUATION; INFUSION; LIVER; METASTASES; MICROSPHERES; NEOPLASMS; PATIENTS; SYMPTOMS; YTTRIUM 90

Citation Formats

Cosin, Octavio, Bilbao, Jose Ignacio, Alvarez, Sergio, Luis, Esther de, Alonso, Alberto, and Martinez-Cuesta, Antonio. Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres. United States: N. p., 2007. Web. doi:10.1007/S00270-006-0028-5.
Cosin, Octavio, Bilbao, Jose Ignacio, Alvarez, Sergio, Luis, Esther de, Alonso, Alberto, & Martinez-Cuesta, Antonio. Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres. United States. doi:10.1007/S00270-006-0028-5.
Cosin, Octavio, Bilbao, Jose Ignacio, Alvarez, Sergio, Luis, Esther de, Alonso, Alberto, and Martinez-Cuesta, Antonio. Thu . "Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres". United States. doi:10.1007/S00270-006-0028-5.
@article{osti_21091053,
title = {Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres},
author = {Cosin, Octavio and Bilbao, Jose Ignacio and Alvarez, Sergio and Luis, Esther de and Alonso, Alberto and Martinez-Cuesta, Antonio},
abstractNote = {Purpose. Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations .Methods. In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results. RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion. RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.},
doi = {10.1007/S00270-006-0028-5},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 30,
place = {United States},
year = {Thu Feb 15 00:00:00 EST 2007},
month = {Thu Feb 15 00:00:00 EST 2007}
}
  • In Canada and Europe, yttrium-90 microspheres (TheraSphere); MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria inmore » Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia.« less
  • BackgroundIntra-arterial brachytherapy with yttrium-90 ({sup 90}Y) resin microspheres (radioembolization) is a procedure to selectively deliver high-dose radiation to tumors. The purpose of this research was to compare the radioembolic effect of {sup 90}Y-radioembolization versus the embolic effect of bland microspheres in the porcine kidney model.MethodsIn each of six pigs, ~25–33 % of the kidney volume was embolized with {sup 90}Y resin microspheres and an equivalent number of bland microspheres in the contralateral kidney. Kidney volume was estimated visually from contrast-enhanced fluoroscopy imaging. Morphologic and histologic analysis was performed 8–9 weeks after the procedure to assess the locations of the microspheres and extentmore » of tissue necrosis from {sup 90}Y-radioembolization and bland embolization. A semi-quantified evaluation of the non-acute peri-particle and perivascular tissue reaction was conducted. All guidelines for the care and use of animals were followed.ResultsKidneys embolized with {sup 90}Y-radioembolization decreased in mass by 30–70 % versus the contralateral kidney embolized with bland microspheres. These kidneys showed significant necrosis/fibrosis, avascularization, and glomerular atrophy in the immediate vicinity of the {sup 90}Y resin microspheres. By contrast, glomerular changes were not observed, even with clusters of bland microspheres in afferent arterioles. Evidence of a foreign body reaction was recorded in some kidneys with bland microspheres, and subcapsular scarring/infarction only with the highest load (4.96 × 10{sup 6}) of bland microspheres.ConclusionThis study showed that radioembolization with {sup 90}Y resin microspheres produces localized necrosis/fibrosis and loss of kidney mass in a porcine kidney model. This result supports the study of {sup 90}Y resin microspheres for the localized treatment of kidney tumors.« less
  • Pseudoaneurysms due to chronic pancreatitis can be a source of major gastrointestinal (GI) hemorrhage. Computed tomography (CT) is the primary diagnostic imaging modality for pancreatic pseudocysts associated with GI bleeding. Pseudoaneurysms and associated GI bleeding can be diagnosed and embolized with transcatheter techniques once the arterial anatomy is defined. CT is a useful modality for follow-up examination of the pseudocyst; the findings must be correlated with other procedures performed on these patients. On follow-up studies, contrast medium retained in the pseudocyst after embolization may falsely signal persistent bleeding into the pseudocyst.
  • Experiments exploring means for the protection of adjacent normal tissue while delivering a destructive dose of radiation to malignant tissue were conducted. By injection of radioactive ceramic spheres or particles, too large to pass through capillaries or arteriovenous shunts, relatively high doses of radiation can be distributed homogeneously to a circumscribed area. Attempts were made to determine the uniformity of distribution and the radiation effect of varying doses of spheres injected into the arterial supply of the dog prostate. Nonradioactive and radioactive ceramic microspheres of 60 mu dia were used since this size exceeds the diameter of capillaries and arteriovenousmore » shunts. Yttrium-90 microspheres of varying radioactivity were used. Doses injected into right and left hypogastric arteries varied from 0.69 to 28.4 mc/side (92-1260 mc/ g prostate). Homogeneous distribution of radioactivity within the prostate was demonstrated by autoradiography. Distribution to some other organs (rectum, penis, and bladder) occurred because arterial supply to these structures was not isolated and occluded. The amount of radioactivity found in the lungs suggested more venous drainage in some cases than seemed apparent, and because of the infarctions of pelvic organs may have leaked radioactive spheres into the venous circuit. In 6 of the 8 dogs which died prematurely (2 to 7 days after surgery) obvious infarction of the prostate and in some other pelvic structures had occurred. That the radioactivity contributed to the infarction is suggested by the results in the dogs which received large doses of radioactivity (18.9 and 28.4 mc per side) in minimal amounts of spheres (100to 150 mg per side). The intensely concentrated radioactivity within the arteriolar lumens may have caused vasculitis and subsequent thrombosis. Although homogeneous destruction of the prostate gland occurred, the effect of a given dose ranged unpredictably through three groups: no apparent effect at all, destruction of the prostate, and early death with infarction of the prostate and other pelvic organs. It was concluded that with the present technique the range between the dose of radioactivity which caused no obvious response and the dose which is related to acute death is too narrow to allow reasonably predictable results, but that further refinement of technique might increase control over tissue destruction.« less
  • To present a critical review of yttrium-90 (TheraSphere) for the treatment of hepatocellular carcinoma (HCC). Medical literature databases (Medline, Cochrane Library, and CANCERLIT) were searched for available literature concerning the treatment of HCC with TheraSphere. These publications were reviewed for scientific and clinical validity. Studies pertaining to the use of yttrium-90 for HCC date back to the 1960s. The results from the early animal safety studies established a radiation exposure range of 50-100 Gy to be used in human studies. Phase I dose escalation studies followed, which were instrumental in delineating radiation dosimetry and safety parameters in humans. These earlymore » studies emphasized the importance of differential arteriolar density between hypervascular HCC and surrounding liver parenchyma. Current trends in research have focused on advancing techniques to safely implement this technology as an alternative to traditional methods of treating unresectable HCC, such as external beam radiotherapy, conformal beam radiotherapy, ethanol ablation, trans-arterial chemoembolization, and radiofrequency ablation. Yttrium-90 (TheraSphere) is an outpatient treatment option for HCC. Current and future research should focus on implementing multicenter phase II and III trials comparing TheraSphere with other therapies for HCC.« less