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

Abstract

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.