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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 4/2013

01-08-2013 | Clinical Investigation

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

Authors: Jens M. Theysohn, Stefan Müller, Jörg F. Schlaak, Judith Ertle, Thomas W. Schlosser, Andreas Bockisch, Thomas C. Lauenstein

Published in: CardioVascular and Interventional Radiology | Issue 4/2013

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Abstract

Purpose

Selective 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).

Methods

After hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin (99mTc-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.

Results

A significant 99mTc-HSA accumulation in the gallbladder wall (higher 99mTc-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.

Conclusion

It 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.
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Metadata
Title
Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery
Authors
Jens M. Theysohn
Stefan Müller
Jörg F. Schlaak
Judith Ertle
Thomas W. Schlosser
Andreas Bockisch
Thomas C. Lauenstein
Publication date
01-08-2013
Publisher
Springer New York
Published in
CardioVascular and Interventional Radiology / Issue 4/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-012-0474-1

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