A descriptive analysis of remnant activity during 90 Y resin microspheres radioembolization of hepatic tumors: technical
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A descriptive analysis of remnant activity during 90Y resin microspheres radioembolization of hepatic tumors: technical factors and dosimetric implications Lidia Sancho Rodrı´guez4 • Sue Ping Thang1 • HuiHua Li2 • Lih Kin Khor3 Young Soon Tay1 • Khin Ohnmar Myint1 • Aaron Kian Ti Tong1
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Received: 29 October 2015 / Accepted: 8 December 2015 Ó The Japanese Society of Nuclear Medicine 2015
Abstract Objective Activity planning for 90Y radioembolization aims to maximize the effect of the treatment while keeping toxicity acceptably low. Our aim was to describe the amount of residual activity in post-treatment v-vials and tubing and analyze the possible factors affecting it (total activity administered, number of split activity injection(s), previous treatments, administration artery and microcatheter size), as these may influence dosimetric planning and treatment. Methods This was a retrospective review using case records of patients who received 90Y-radioembolization for hepatic tumors at a single tertiary center. From August 2013 to September 2015, seventy-seven out of one hundred and fifty patients who received radioembolization with 90Y resin microspheres due to inoperable Hepatocellular Carcinoma (HCC) or liver metastases were included. The rest were mainly excluded due to incomplete data sets. The number of split activities (injections) for the radioembolization could be: one single injection, two or three. The remnant activity in post-treatment v-vials and tubing were & Lidia Sancho Rodrı´guez [email protected] 1
Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
2
Division of Research, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
3
Department of Diagnostic Imaging, National University Hospital, Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
4
Department of Nuclear Medicine, Clı´nica Universidad de Navarra, Avenida Pio XII, 36, Pamplona, 31008 Navarra, Spain
measured for every patient. The administration arteries evaluated were: proper hepatic artery (PHA), right hepatic artery (RHA), middle hepatic artery (MHA), left hepatic artery (LHA) and small caliber branch arteries. The sizes of the microcatheters (2.2 or 2.7 Fr) used to administer the dose were also evaluated. Results In total, 77 out of 150 patients were included in the final analysis. There were 59 men of median age 64.0 years old. The total median dose loss was 0.10 GBq. The total dose loss increased 0.244 GBq [95 % CI = (0.169, 0.318)] when three split activities were given compared to single activity injection. Activity loss for each injection increased 0.0297 GBq [95 % CI = (0.0151, 0.0443)] for every 1.0 GBq increase of split activity injection. There were no significant statistical differences in the rest of patient characteristics. Conclusions There is significant loss of activity observed during radioembolization, which can have a major dosimetric impact. The total administered activity and the number of split injection
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