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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2015

01-04-2015 | Clinical Investigation

Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

Authors: Carlo Spreafico, Carlo Morosi, Marco Maccauro, Raffaele Romito, Rodolfo Lanocita, Enrico M. Civelli, Carlo Sposito, Sherrie Bhoori, Carlo Chiesa, Laura F. Frigerio, Alice Lorenzoni, Tommaso Cascella, Alfonso Marchianò, Vincenzo Mazzaferro

Published in: CardioVascular and Interventional Radiology | Issue 2/2015

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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.
Literature
1.
Geschwind JF, Salem R, Carr BI et al (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127:S194–S205CrossRefPubMed
2.
Carr BI (2004) Hepatic arterial 90-yttrium glass microspheres (TheraSphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transplant 10:S107–S110CrossRef
3.
Salem R, Lewandowski RJ, Atassi B et al (2005) Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 16:1627–1639CrossRefPubMed
4.
Hilgard P, Hamami M, Fouly AE et al (2010) Radioembolization with Yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 52(5):1741–1749CrossRefPubMed
5.
Mazzaferro V, Sposito C, Bhoori S et al (2013) Yttrium (90) radioembolization for intermediate-advanced hepatocarcinoma: a phase II study. Hepatology 57(5):1826–1837CrossRefPubMed
6.
Ibrahim SM, Lewandowski RJ, Sato KT et al (2008) Radioembolization for the treatment of unresectable hepatocellular carcinoma: a clinical review. World J Gastroenterol 14:1664–1669CrossRefPubMedCentralPubMed
7.
Young JY, Rhee TK, Atassi B et al (2007) Radiation dose limits and liver toxicities resulting from multiple Yttrium-90 radioembolization treatments for hepatocellular carcinoma. J Vasc Interv Radiol 18:1375–1382CrossRefPubMed
8.
Riaz A, Lewandowski RJ, Kulik LM et al (2009) Complications following radioembolization with Yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 20(9):1121–1130CrossRefPubMed
9.
Kennedy A, Nag S, Salem R et al (2007) Recommendations for radio-embolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the Radio-embolization Brachytherapy Oncology Consortium (REBOC). Int J Radiat Oncol Biol Phys 68:13–23CrossRefPubMed
10.
Abdelmaksoud MH, Louie JD, Kothary N et al (2011) Embolization of parasitized extrahepatic arteries to re-establish intrahepatic arterial supply to tumors before yttrium-90 radioembolization. J Vasc Interv Radiol 22(10):1355–1362CrossRefPubMed
11.
Abdelmaksoud MH, Louie JD, Kothary N et al (2011) Consolidation of hepatic arterial inflow by embolization of variant hepatic arteries in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 22(10):1364–1371CrossRefPubMed
12.
Bilbao JI, Garrastachu P, Maria J, Herraiz MJ et al (2010) Safety and efficacy assessment of flow redistribution by occlusion of intrahepatic vessels prior to radioembolization in the treatment of liver tumors. Cardiovasc Interv Radiol 33(3):523–531CrossRef
13.
Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60CrossRefPubMed
14.
National Cancer Institute (29 May 2009) Common Terminology Criteria for Adverse Events v4.0 NCI, NIH, DHHS. NIH publication number 09-7473
15.
Chiesa C, Maccauro M, Romito R, Spreafico C et al (2011) Need, feasibility and convenience of dosimetric treatment planning in liver selective internal radiation therapy with 90Y microspheres: the experience of National Cancer Institute of Milan. Q J Nucl Med Mol Imaging 55:168–197PubMed
16.
Salem R, Lewandowski RJ, Kulik L et al (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507CrossRefPubMedCentralPubMed
17.
Chiesa C, Mira M, Maccauro M, Romito R, Spreafico C, Sposito C, Bhoori S, Morosi C, Pellizzari S, Negri A, Civelli E, Lanocita R, Camerini T, Bampo C, Carrara M, Seregni E, Marchianò A, Mazzaferro V, Bombardieri E (2012) A dosimetric treatment planning strategy in radioembolization of hepatocarcinoma with 90Y glass microspheres. Q J Nucl Med Mol Imaging 56(6):503–508PubMed
18.
Sebastian AJ, Szyszko T, Al-Nahhas A, Nijran K, Tait NP (2008) Evaluation of hepatic angiography procedures and Bremsstrahlung imaging in selective internal radiation therapy: a two-year single-center experience. Cardiovasc Interv Radiol 31:643–649CrossRef
19.
20.
Chuang VP, Wallace S (1980) Hepatic arterial redistribution for intraarterial infusion of hepatic neoplasms. Radiology 135:295–299CrossRefPubMed
21.
Charnsangavej C, Chuang VP, Wallace S, Soo CS, Bowers T (1982) Angiographic classification of hepatic arterial collaterals. Radiology 144:485–494CrossRefPubMed
22.
Arai Y, Yakeuchi Y, Inaba Y et al (2007) Percutaneous catheter placement for hepatic arterial infusion chemotherapy. Tech Vasc Interv Radiol 10:30–37CrossRefPubMed
23.
Ganeshan A, Upponi S, Hon LQ, Warakaulle D, Uberoi R (2008) Arterial infusion of chemotherapy: the role of diagnostic and interventional radiology. Ann Oncol 19:847–851CrossRefPubMed
24.
Tanaka T, Arai Y, Inaba Y et al (2003) Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 14:63–68CrossRefPubMed
25.
Cho A, Gunji H, Koike N et al (2007) Intersegmental arterial communication between the medial and left lateral segments of the liver. Dig Surg 24:328–330CrossRefPubMed
26.
Gunji H, Cho A, Tohma T et al (2006) The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 192:276–280CrossRefPubMed
27.
Tohma T, Cho A, Okazumi S et al (2005) Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 237:361–365CrossRefPubMed
28.
Miyazaki M, Ito H, Nkagawa K et al (2000) Unilateral hepatic artery reconstruction is unnecessary in biliary tract carcinomas involving lobar hepatic artery: implications of interlobar hepatic artery and its preservation. Hepatogastroenterology 47:1526–1530PubMed
29.
Sone M, Kato K, Hirose A et al (2008) Impact of multislice CT angiography of radiological catheter placement for hepatic arterial infusion chemotherapy. Cardiovasc Interv Radiol 31:91–97CrossRef
30.
Wallace MJ, Murthy R, Kammat PP et al (2007) Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol 18:1500–1507CrossRefPubMed
Metadata
Title
Intrahepatic Flow Redistribution in Patients Treated with Radioembolization
Authors
Carlo Spreafico
Carlo Morosi
Marco Maccauro
Raffaele Romito
Rodolfo Lanocita
Enrico M. Civelli
Carlo Sposito
Sherrie Bhoori
Carlo Chiesa
Laura F. Frigerio
Alice Lorenzoni
Tommaso Cascella
Alfonso Marchianò
Vincenzo Mazzaferro
Publication date
01-04-2015
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 2/2015
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-014-0921-2

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