Radioembolization: Concepts and Procedures

  1. Arbizu, Javier 1
  2. Bilbao, José I. 1
  3. Garrastachu, Puy 1
  4. Rodriguez-Fraile, Macarena 1
  5. Domínguez-Prado, Inés 1
  6. Iñarrairaegui, Mercedes 1
  7. Sangro, Bruno 1
  1. 1 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

Libro:
Therapeutic Nuclear Medicine

Editorial: Springer

ISSN: 0942-5373,  2197-4187

ISBN: 9783540367185,  9783540367192

Año de publicación: 2014

Páginas: 361-377

Tipo: Capítulo de Libro

DOI: 10.1007/174_2012_793 GOOGLE SCHOLAR lock_openAcceso abierto editor

Resumen

Radioembolization (RE) is a form of intravascular brachytherapy that consists in delivering implantable radioactive microspheres into the arteries that feed liver tumors in order to provide a high dose of radiation to tumor nodules irrespective of their number, size, and location, while preserving the non-tumoral liver tissue from receiving a harmful level of radiation. The nature of the procedure using Yttrium-90 RE (Y-90 RE) requires the collaboration of a multidisciplinary team including hepatologists or oncologists, interventional radiologists and nuclear medicine specialists working together in close collaboration. To avoid toxicity, a thorough angiographic evaluation is performed to identify every extrahepatic vessel that may feed the tumors (to assure efficiency), accomplished with Tc-99m labeled macroaggregated albumin (Tc-MAA) injection into the vessel of interest, in order to mimic the microsphere application during the treatment. Both procedures combined are essential to plan the radioembolization (RE) therapy and to detect any occult arteriovenous shunt from the hepatic arterial system to the pulmonary or gastrointestinal venous systems and so identify potentially to calculate the degree of hepatopulmonary shunting, and to detect and eventually occlude every collateral vessel that arising from a hepatic artery may carry microspheres to the GI tract or other extrahepatic organs. With all this information, the treatment is designed and activity is calculated in order to maximize the dose of radiation delivered to liver tumors while safely preserving the non-tumoral parenchyma.

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