Winfred Xi Tai Goh1, Sum Leong2,3, Chow Wei Too4,5, Lionel Tim-Ee Cheng4,6, Seyed Ehsan Saffari7, Rebekah Zhuyi Lee1, Sean Tze Shen Ng1, Richard Hoau Gong Lo4,5, Kiang Hiong Tay4,5, Shaun Xavier Ju Min Chan4,5, Apoorva Gogna4,5, Farah Gillan Irani4,5, Nanda Venkatanarasimha4,5, Kelvin Siu Hoong Loke4,8, Pierce Kah Hoe Chow9,10,11, David Chee Eng Ng4,8, Thijs August Johan Urlings12, Ankur Patel4,5, Karthikeyan Damodharan4,5, Luke Han Wei Toh4,5, Bien Soo Tan4,5. 1. MOH Holdings Pte Ltd, Singapore, Singapore. 2. Office of Academic and Clinical Development, Duke-NUS Medical School, Singapore, Singapore. leong.sum@singhealth.com.sg. 3. Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore. leong.sum@singhealth.com.sg. 4. Office of Academic and Clinical Development, Duke-NUS Medical School, Singapore, Singapore. 5. Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore. 6. Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore. 7. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore. 8. Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore. 9. Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore. 10. Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore. 11. Office of Clinical Sciences, Academic and Faculty Affairs, Duke-NUS Medical School, Singapore, Singapore. 12. Haaglanden Medical Centre, The Hague, The Netherlands.
Abstract
OBJECTIVES: To determine the rate of prophylactic embolization of extrahepatic vessels in patients undergoing yttrium-90 selective internal radiotherapy (90Y SIRT) for hepatocellular carcinoma (HCC) with the use of catheter-directed computed tomography hepatic angiography (CD-CTHA). MATERIALS AND METHODS: This retrospective study included 186 HCC patients who received 90Y SIRT from May 2010 to June 2015 in a single institution. All procedures were performed in a hybrid angiography-CT suite equipped with digital subtraction angiography (DSA) and CD-CTHA capabilities. CD-CTHA was performed during pre-treatment hepatic angiography. 90Y SIRT was administered approximately 2 weeks later. Selective prophylactic embolization of extrahepatic vessels was performed if extrahepatic enhancement was seen on CD-CTHA or if an extrahepatic vessel opacified on DSA/CD-CTHA despite the final microcatheter position for 90Y microsphere delivery being beyond the origin of this vessel. RESULTS: Thirty-five patients (18.8%) required selective embolization of extrahepatic vessels. Technical success of 90Y SIRT was 99.5%. Two patients (1.1%) developed radiation-induced gastrointestinal ulceration, and one (0.54%) developed radiation-induced pneumonitis. Extrahepatic uptake of 90Y microspheres was seen in the gallbladder of one patient without significant complications. CONCLUSION: The use of CD-CTHA in 90Y SIRT of HCC was associated with a low rate of prophylactic embolization of extrahepatic vessels while maintaining a high technical success rate of treatment and low rate of complications. LEVEL OF EVIDENCE: Level 4, case series.
OBJECTIVES: To determine the rate of prophylactic embolization of extrahepatic vessels in patients undergoing yttrium-90 selective internal radiotherapy (90Y SIRT) for hepatocellular carcinoma (HCC) with the use of catheter-directed computed tomography hepatic angiography (CD-CTHA). MATERIALS AND METHODS: This retrospective study included 186 HCCpatients who received 90Y SIRT from May 2010 to June 2015 in a single institution. All procedures were performed in a hybrid angiography-CT suite equipped with digital subtraction angiography (DSA) and CD-CTHA capabilities. CD-CTHA was performed during pre-treatment hepatic angiography. 90Y SIRT was administered approximately 2 weeks later. Selective prophylactic embolization of extrahepatic vessels was performed if extrahepatic enhancement was seen on CD-CTHA or if an extrahepatic vessel opacified on DSA/CD-CTHA despite the final microcatheter position for 90Y microsphere delivery being beyond the origin of this vessel. RESULTS: Thirty-five patients (18.8%) required selective embolization of extrahepatic vessels. Technical success of 90Y SIRT was 99.5%. Two patients (1.1%) developed radiation-induced gastrointestinal ulceration, and one (0.54%) developed radiation-induced pneumonitis. Extrahepatic uptake of 90Y microspheres was seen in the gallbladder of one patient without significant complications. CONCLUSION: The use of CD-CTHA in 90Y SIRT of HCC was associated with a low rate of prophylactic embolization of extrahepatic vessels while maintaining a high technical success rate of treatment and low rate of complications. LEVEL OF EVIDENCE: Level 4, case series.