Radioembolization follow

Andrews JC, Walker SC, Ackermann RJ et al (1994) Hepatic radioembolization with yttrium-90 containing glass microspheres preliminary results and clinical follow-up. J Nucl Med 35 1637-1644... 

The more mature data currently available in the literature regarding the use of SIR-Spheres in metastatic breast cancer have been recently reported in a peer-reviewed format by Coldwell and colleagues [37]. The authors evaluated the feasibility, side effects, and complications of radioembolization in the treatment of breast cancer metastases to the liver. Enrollment was limited to those patients who had an Eastern Cooperative Group performance score of 0 or 1 and an expected survival of at least 3 months. All patients have been previously treated with systemic chemotherapy and/or trastuzumab. Patients were excluded if brain metastases were present or total bilirubin exceeded 2 mg/dl. Bone metastases did not exclude patients. Baseline PET scans were obtained and patients were followed with CT and PET scans every 3 months. 

Fig. 14.1. TIPS placement in a 54-year-old woman who developed radiation induced liver disease. She developed abnormal liver function tests with elevated alkaline phosphatase levels and portal hypertension 1 month following radioembolization of liver metastasis from breast carcinoma...

Background. Biliary complications both intra- and extrahepatic following administration are due to the embolic and radiation induced necrosis of the biliary ducts [29]. In contrast to the normal liver parenchyma, the intrahepatic bile ducts do not have a dual blood supply and are fed exclusively from the hepatic arterial branches that give off a vascular plexus (peribiliary capillary plexus) around the bile ducts. This microscopic peribiliary arterial plexus has a similar diameter to that of the microspheres (10-60 pm, mean 35 pm). Therefore, ischaemia of the intrahepatic bile ducts can occur after radioembolization [25]. 

Radioembolization with yttrium-90 ( Y) microspheres represents an innovative approach that has gained increasing awareness and clinical use over the past 5-10 years. The minimal toxicity of radioembolization and the ability to discharge the patient on an outpatient basis make the therapy an attractive alternative in the treatment of primary and metastatic liver malignancies. Patients are able to resume normal activities shortly following treatment, with minimal side effects, in contrast to the post-embolization syndrome often associated with current chemoembolic techniques. 

Similar to hepatic artery chemoembolization, patients with bilobar disease should be treated in a lobar fashion at staged time intervals, usually 30-60 days following the first treatment. Patients eligibility for repeat radioembolization should be evaluated following every treatment. Patients on chemotherapy should have this therapy discontinued two weeks prior to radioembolization. Chemotherapy may be restarted two weeks following radioembolization. 

All patients being evaluated for radioembolization should have the following angiographic evaluation [14] ... 

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