The Efficacy of Coil Embolization to Obtain Intrahepatic Redistribution in Radioembolization: Qualitative and Quantitative Analyses
Purpose: To evaluate the efficacy of coil embolization to obtain intrahepatic redistribution in patients undergoing radioembolization. Materials and Method: All patients treated with radioembolization at our institute were retrospectively analyzed, and all cases in which a tumor-feeding vessel was coil-embolized were selected. Two nuclear medicine physicians visually assessed the effect of redistribution. Furthermore, the redistribution of microspheres was measured by quantifying the activity distributed to the coil-embolized (dependent) segment relative to the other (non-dependent) segments and to the tumor(s) in that segment. Quantitative analysis was performed on post-treatment 90Y-PET and 166Ho-SPECT using Simplicit90Y software. Lesion response was measured according to RECIST 1.1 criteria at 3 months post-treatment. Results: Out of 37 cases, 32 were suitable for quantitative analysis and 37 for qualitative analysis. In the qualitative analysis, redistribution was deemed successful in 69% of cases. The quantitative analysis showed that the median ratio of the activity to the dependent embolized segments and the non-dependent segments was 0.88 (range 0.26–2.05) and 0.80 (range 0.19–1.62) for tumors in dependent segments compared with tumors in non-dependent segments. Using a cutoff ratio of 0.7 (30% lower activity concentration in comparison with the rest of the liver), 57% of cases were successful. At 3 months post-treatment, 6% of dependent tumors had partial response, 20% progressive disease, and 74% stable disease. In non-dependent tumors, this was, respectively, 16%, 20%, and 64%. Conclusion: Coil embolization of hepatic arteries to induce redistribution of microspheres has a limited success rate. Qualitative assessment tends to overrate redistribution.
|Keywords||Intrahepatic redistribution, Quantitative analysis, Transarterial radioembolization|
|Persistent URL||dx.doi.org/10.1007/s00270-019-02351-1, hdl.handle.net/1765/120948|
|Journal||CardioVascular and Interventional Radiology|
Alsultan, A.A. (Ahmed A.), van Roekel, C. (Caren), Barentsz, M.W. (Maarten W.), Braat, A.J.A.T. (Arthur J. A. T.), van Doormaal, P.J. (Pieter Jan), Lam, M.G.E.H. (Marnix G. E. H.), & Smits, M.L.J. (Maarten L. J.). (2019). The Efficacy of Coil Embolization to Obtain Intrahepatic Redistribution in Radioembolization: Qualitative and Quantitative Analyses. CardioVascular and Interventional Radiology. doi:10.1007/s00270-019-02351-1