First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation. - Université de Rennes Accéder directement au contenu
Article Dans Une Revue European Journal of Nuclear Medicine Année : 2010

First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation.

Résumé

OBJECTIVES: We report a first experience involving the use of (90)Y radiolabelled microspheres (TheraSphere) for the treatment of mainly primary hepatic tumours. MATERIALS AND METHODS: Treatment using TheraSphere microspheres was planned in 15 patients (13 with hepatocellular carcinoma, 2 with neuroendocrine tumour metastases). The treatment was preceded by a first angiography aimed at embolizing the vascularizing arterial branches of other structures outside the liver and evaluating the percentage of pulmonary shunt by scintiscanning after perfusion with (99m)Tc-MAA. The objective of the treatment carried out during a second angiography was to deliver a dose of 120+/-20 Gy (mean+/-SD) to the target hepatic volume. RESULTS: Technical difficulties were encountered in embolizing gastroduodenal or gastric branches in two patients and in one patient these led to cancellation of the treatment. A total of 14 patients were treated with an average activity of 3.18 GBq. In one patient, the injection was defective (stagnation of microspheres at the outlet of the catheter). SPECT/CT acquisitions provided important information in four patients (visualization of the gallbladder in three; visualization of the stomach in one, leading to a new coiling). The average exposure of the nuclear medicine physician carrying out the injections was 64+/-80 microSv at the fingers. A partial response was seen in six patients, stabilization in five and progression in three. One patient presented with a gastric ulcer and two showed an increase in their hepatocellular insufficiency. CONCLUSION: Although sometimes technically difficult, the use of TheraSphere microspheres is a worthwhile therapeutic approach because of the low level exposure of operators and the encouraging rate of response or stabilization. The use of SPECT/CT contributes greatly to helping therapeutic planning, especially in the learning curve or when the angiographic procedure is difficult.

Dates et versions

hal-00742174 , version 1 (16-10-2012)

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Citer

Etienne Garin, Yan Rolland, Eveline Boucher, Valérie Ardisson, Sophie Laffont, et al.. First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation.. European Journal of Nuclear Medicine, 2010, 37 (3), pp.453-61. ⟨10.1007/s00259-009-1279-6⟩. ⟨hal-00742174⟩
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