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Purpose: To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total).

Methods: IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records.

Results: Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity <10 mCi, treatment of smaller liver volumes (<200 ml) and documentation of stasis were associated with higher residual activity ( P = 0.025, P = 0.0007, P = 0.0177, and P = 0.049, respectively) were associated with higher residuals.

Conclusion: Combining the new technologies of SIROS and the Truselect microcatheter with a double-flush protocol yielded <10% residual in 94% of y90 infusions. Future studies may clarify if the predictors of high residual dose seen here may warrant microcatheter-specific considerations for dosimetry or dose preparation at the Radiopharmacy level.

Titel:	Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol.
Autor/in / Beteiligte Person:	Sag, AA ; Agritelley, E ; Ronald, J ; Young, SJ ; Kim, CY
Zeitschrift:	Nuclear medicine communications, Jg. 45 (2024), Heft 1, S. 61-67
Veröffentlichung:	London : Lippincott Williams & Wilkins ; <i>Original Publication</i>: London : Chapman and Hall in association with the British Nuclear Medicine Society, c1980-, 2024
Medientyp:	academicJournal
ISSN:	1473-5628 (electronic)
DOI:	10.1097/MNM.0000000000001784
Schlagwort:	Humans Injections Retrospective Studies Yttrium Radioisotopes therapeutic use Embolization, Therapeutic Liver Neoplasms diagnostic imaging Liver Neoplasms radiotherapy Liver Neoplasms drug therapy Carcinoma, Hepatocellular therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Nucl Med Commun] 2024 Jan 01; Vol. 45 (1), pp. 61-67. <i>Date of Electronic Publication: </i>2023 Oct 30. MeSH Terms: Embolization, Therapeutic* ; Liver Neoplasms* / diagnostic imaging ; Liver Neoplasms* / radiotherapy ; Liver Neoplasms* / drug therapy ; Carcinoma, Hepatocellular* / therapy ; Humans ; Injections ; Retrospective Studies ; Yttrium Radioisotopes / therapeutic use References: Villalobos A, Arndt L, Cheng B, Dabbous H, Loya M, Majdalany B, et al. Yttrium-90 radiation segmentectomy of hepatocellular carcinoma: a comparative study of effectiveness, safety, and dosimetry of glass vs resin-based microspheres. J Vasc Interv Radiol 2023; 34:1226–1234. ; Kolligs F, Arnold D, Golfieri R, Pech M, Peynircioglu B, Pfammatter T, et al.; CIRT Principal Investigators. Factors impacting survival after transarterial radioembolization in patients with hepatocellular carcinoma: Results from the prospective CIRT study. JHEP Rep 2023; 5:100633. ; Arslan N, Ince S, Okuyucu K, San H, Alagoz E, Karadurmus N, et al. Yttrium-90 (Y-90) resin microsphere therapy for patients with unresectable hepatocellular carcinoma Identification of successful treatment response predictors and patient selection. Ann Ital Chir 2021; 92:623–631. ; Feely M, Tondon R, Gubbiotti M, Stashek KM, Numbere N, Huber AR, et al. Gastrointestinal tract injury by yttrium-90 appears largely restricted to resin microspheres but can occur years after embolization. Am J Surg Pathol 2022; 46:1234–1240. ; Levillain H, Bagni O, Deroose CM, Dieudonné A, Gnesin S, Grosser OS, et al. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur J Nucl Med Mol Imaging 2021; 48:1570–1584. ; Drescher R, Gühne F, Seifert P, Kühnel C, Freesmeyer M. Ex vivo evaluation of residual activity and infusion dynamics in a commercially available yttrium-90 resin microsphere administration system. J Vasc Interv Radiol 2019; 30:1504–1511. ; Malhotra A, Liu DM, Talenfeld AD. Radiation segmentectomy and radiation lobectomy: a practical review of techniques. Tech Vasc Interv Radiol 2019; 22:49–57. ; Instructions for Use, SIR-Spheres Ytrrium-90 Microspheres, IFU-005-EU Rev. 01; 14 Oct 2022 (CR 3084) (Sirtex). ; Instructions for Use, Therasphere Yttrium-90 Glass Microspheres, Boston Scientific. Rev 1 (03/2021). ; Rodríguez LS, Thang SP, Li H, Khor LK, Tay YS, Myint KO, et al. A descriptive analysis of remnant activity during (90)Y resin microspheres radioembolization of hepatic tumors: technical factors and dosimetric implications. Ann Nucl Med 2016; 30:255–261. ; Instructions for Use, Truselect Microcatheter, Boston Scientific. Rev 1 (03/2021). ; Lewandowski RJ, Salem R. Yttrium-90 radioembolization of hepatocellular carcinoma and metastatic disease to the liver. Semin Intervent Radiol 2006; 23:64–72. ; Savin MA, Chehab M, Campbell JM, Savin JH, Cash C, Wong CY, et al. Yttrium-90 infusion: incidence and outcome of delivery system occlusions during 885 deliveries. J Vasc Interv Radiol 2015; 26:1769–1776. ; Schultz CC, Campbell J, Bakalyar D, Beauvais M, Feng W, Savin M. Y-90 microsphere therapy: prevention of adverse events. Cancer Biother Radiopharm 2009; 24:427–433. ; Hoang NS, Khalaf MH, Rosenberg JK, Kwofie J, Reposar AL, Wang DS, et al. Quantification of activity lost to delivery-system residual and decay in yttrium-90 radioembolization. J Vasc Interv Radiol 2018; 29:1672–1677. ; Ahmadzadehfar H, Meyer C, Pieper CC, Bundschuh R, Muckle M, Gärtner F, et al. Evaluation of the delivered activity of yttrium-90 resin microspheres using sterile water and 5 % glucose during administration. EJNMMI Res. 2015; 5:54. Substance Nomenclature: 0 (Yttrium Radioisotopes) Entry Date(s): Date Created: 20231030 Date Completed: 20231216 Latest Revision: 20231216 Update Code: 20231217

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Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol.