Ex Vivo Evaluation of Residual Activity and Infusion Dynamics in a Commercially Available Yttrium-90 Resin Microsphere Administration System

Published on Sep 1, 2019in Journal of Vascular and Interventional Radiology3.037
· DOI :10.1016/J.JVIR.2018.10.019
Robert Drescher5
Estimated H-index: 5
,
Falk Gühne4
Estimated H-index: 4
+ 2 AuthorsMartin Freesmeyer14
Estimated H-index: 14
Source
Abstract
Abstract Purpose To evaluate the infusion dynamics and residual yttrium-90 activity during and after resin microsphere radioembolization with different injection techniques and initial activities. To assess the distribution of residual activity in the administration systems to allow optimization of the procedure and the equipment. Materials and Methods In a setup similar to that in standard clinical practice, radioembolization procedures were performed ex vivo. The influence of different injection techniques was assessed by comparing pulsatile and continuous injections. The influence of the absolute amount of activity to the residual activity was assessed by comparing pulsatile 0.5-GBq- with 1.0-GBq-procedures. Continuous dose rate measurements were performed. Activity distribution was determined by positron-emission tomography (PET)/CT. Results Fifteen procedures were performed: 5 pulsatile 0.5-GBq-, 5 continuous 0.5-GBq-, and 5 pulsatile 1.0-GBq-procedures. Mean residual activity was 4.0% ± 1.7% (range 1.2%–6.6%), without statistically significant differences between injection techniques (P = .841) or between prescribed activities (P = .222). Dose-rate measurements revealed an exponential decrease of the activities in the vials with high variability. Activity fell rapidly to 32% ± 7.9% (range 23%–55%) after injection of 4 of 20 mL 5% dextrose solution. Residual activity accumulations were identified at the 3-way stopcock (100% of procedures), in the C-line (80%), at the microcatheter connector (20%), and in the A-line (6.7%), but not in the vials. Conclusions Residual activity in a commercial administration system for resin microsphere radioembolization is variable and does not systematically depend on initial yttrium-90 activity or on injection technique. Predilection sites for residual activity were identified, which should receive special attention when performing resin transarterial radioembolization procedures, and for further administration system developments.
📖 Papers frequently viewed together
1 Citations
8 Citations
References13
Newest
#1Riad Salem (NU: Northwestern University)H-Index: 92
#2Ahmed Gabr (NU: Northwestern University)H-Index: 15
Last. Robert J. Lewandowski (NU: Northwestern University)H-Index: 68
view all 27 authors...
: Yttrium-90 transarterial radioembolization (TARE) is a locoregional therapy (LRT) for hepatocellular carcinoma (HCC). In this study, we present overall survival (OS) outcomes in a 1,000-patient cohort acquired over a 15-year period. Between December 1, 2003 and March 31, 2017, 1,000 patients with HCC were treated with TARE as part of a prospective cohort study. A comprehensive review of toxicity and survival outcomes was performed. Outcomes were stratified by baseline Child-Pugh (CP) class, Un...
91 CitationsSource
#1D. MrdjaH-Index: 10
#2Kristina BikitH-Index: 7
Last. Jovana KnezevicH-Index: 1
view all 6 authors...
It is well known that protection from the external irradiation produced by beta emitters is simpler than the corresponding shielding of radioactive sources that emit gamma radiation. This is caused by the relatively strong absorption (i.e. short range) of electrons in different materials. However, for strong beta sources specific attention should be paid to the bremsstrahlung radiation induced in the source encapsulation (matrix), especially for emitters with relatively high beta-endpoint energy...
4 CitationsSource
1 CitationsSource
#1Pavan NajranH-Index: 4
#2Angela LamarcaH-Index: 19
Last. Juan W Valle (MAHSC: Manchester Academic Health Science Centre)H-Index: 61
view all 10 authors...
Cholangiocarcinoma is a rare form of gastrointestinal cancer with a poor prognosis. Patients often present with biliary obstruction or non-specific abdominal pain, and a high proportion of patients have advanced disease at initial diagnosis. The goal of this review is to discuss treatment options for patients with advanced bile duct tumours focusing on radioembolisation (RE) and its impact on overall survival. RE provides a therapeutic option for patients with unresectable cholangiocarcinoma. Ho...
19 CitationsSource
#1Cherng Chao (UPenn: University of Pennsylvania)H-Index: 1
Last. Michael C. SoulenH-Index: 68
view all 7 authors...
PurposeThe objective of this study was to evaluate the effect of substituting 50% Isovue (Bracco Diagnostics Inc, Monroe Township, NJ) for sterile water on the delivery of 90Y resin microspheres (SIR-Spheres [Sirtex Medical Limited, Sydney, Australia]).Materials and MethodsThe authors retrospectivel
10 CitationsSource
#1Seunghong Rhee (KU: Korea University)H-Index: 6
#2Sungeun Kim (KU: Korea University)H-Index: 19
Last. Jae Gol Choe (KU: Korea University)H-Index: 13
view all 9 authors...
Objectives The purpose of this study is to evaluate the correlation between pretreatment planning technetium-99m (99mTc) macroaggregated albumin (MAA) SPECT images and posttreatment transarterial radioembolization (TARE) yttirum-90 (90Y) PET/CT images by comparing the ratios of tumor-to-normal liver counts.
12 CitationsSource
#1Hojjat Ahmadzadehfar (University Hospital Bonn)H-Index: 36
#2Carsten H. Meyer (University Hospital Bonn)H-Index: 50
Last. Markus Essler (University Hospital Bonn)H-Index: 37
view all 8 authors...
Background The purpose of this study is to evaluate the impact of switching from sterile water to 5 % glucose (G5W) for the administration of yttrium-90 (90Y)-resin microspheres on the total activity of 90Y administered (expressed as a proportion of the prescribed/calculated activity), as well as the number of cases of stasis and the reported incidence of discomfort during the selective internal radiation therapy (SIRT) procedure.
20 CitationsSource
#1Ali Asgar Attarwala (Heidelberg University)H-Index: 8
#2Flavia Molina-Duran (Heidelberg University)H-Index: 3
Last. Gerhard Glatting (Heidelberg University)H-Index: 2
view all 7 authors...
Yttrium-90 is known to have a low positron emission decay of 32 ppm that may allow for personalized dosimetry of liver cancer therapy with 90Y labeled microspheres. The aim of this work was to image and quantify 90Y so that accurate predictions of the absorbed dose can be made. The measurements were performed within the QUEST study (University of Sydney, and Sirtex Medical, Australia). A NEMA IEC body phantom containing 6 fillable spheres (10–37 mm ∅) was used to measure the 90Y distribution wit...
31 CitationsSource
#1Lourens Bester (UNSW: University of New South Wales)H-Index: 20
#2Baerbel Meteling (UNSW: University of New South Wales)H-Index: 7
Last. David L. Morris (UNSW: University of New South Wales)H-Index: 90
view all 5 authors...
Summary Liver-directed therapies are continuing to evolve in the field of interventional oncology and are gaining increasing use in the treatment of unresectable primary and secondary liver cancers. In this article, we review two liver-directed therapies that are currently used for the palliative treatment of primary and secondary hepatic tumours: transcatheter arterial chemoembolisation (TACE), including a new type of TACE with drug-eluting beads (DEB-TACE), and radioembolisation. The concept o...
32 CitationsSource
#1Peachy Mae Piana (Thomas Jefferson University)H-Index: 2
#2Voichita Bar (Thomas Jefferson University)H-Index: 1
Last. Daniel B. Brown (Thomas Jefferson University)H-Index: 32
view all 9 authors...
Objectives This study was conducted to determine the incidence of early stasis in radioembolization using resin yttrium-90 (Y-90) microspheres, to evaluate potential contributing factors, and to review initial imaging outcomes.
22 CitationsSource
Cited By2
Newest
PURPOSE To evaluate the microsphere outflow dynamics and residual Ho-166 activity during and after transarterial radioembolization planning and treatment procedures, and to assess the distribution and predilection sites of residual activity in the proprietary delivery set and the microcatheter. MATERIALS AND METHODS Fifteen planning and 12 therapeutic radioembolization procedures were performed with poly-l-lactic acid microspheres loaded with Ho-166. The amount and distribution of residual activ...
Source
Abstract Purpose To evaluate the microsphere flow dynamics and residual yttrium-90 (90Y) activity during and after transarterial radioembolization with glass microspheres and to assess the distribution and predilection sites of residual activity in the administration devices. Materials and Methods In this laboratory investigation, after 18 consecutive clinical transarterial radioembolization and 4 ex vivo experimental procedures with 90Y glass microspheres, the distribution of residual activity ...
1 CitationsSource