Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

Journal Article · Thu Aug 01 04:00:00 EDT 2013 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-012-0474-1· OSTI ID:22121755

Mueller, Stefan ^[1]; Schlaak, Joerg F.; Ertle, Judith ^[2]; Schlosser, Thomas W. ^[3]; Bockisch, Andreas ^[1]; Lauenstein, Thomas C. ^[3]

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1. University Hospital Essen, Department of Nuclear Medicine (Germany)
2. University Hospital Essen, Department of Gastroenterology and Hepatology (Germany)
3. University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany)

PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin ({sup 99}mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, or a positive Murphy sign, were assessed during patient follow-up.ResultsA significant {sup 99}mTc-HSA accumulation in the gallbladder wall (higher {sup 99}mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position.

• OSTI ID: 22121755
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 4 Vol. 36; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ALBUMINS
ANTIBIOTICS
ARTERIES
BILIARY TRACT
BIOMEDICAL RADIOGRAPHY
BLOOD SERUM
FEVER
HEALTH HAZARDS
IRRADIATION
LIVER
NEOPLASMS
PAIN
PATIENTS
RADIOTHERAPY
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
TECHNETIUM 99
YTTRIUM 90