Prospective Study of Systemic Yttrium-90 Elution during Radioembolization of Hepatic Metastases
Does blood radioactivity differ based on Y90 delivery method?
Take away point
Y90 delivery with 50% contrast in saline solution resulted in a significant blood radioactivity increase compared to delivery in D5W.
Alexander ES, Pantel AR, Carlin SD, Beckmann N, Mick R, Pryma DA, Soulen MC. Prospective Study of Systemic Yttrium-90 Elution during Radioembolization of Hepatic Metastases. J Vasc Interv Radiol. 2020 Dec;31(12):2007-2013.e1. doi: 10.1016/j.jvir.2020.08.011. Epub 2020 Nov 2. PMID: 33143997.
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Single center prospective
Academic hospital. University of Pennsylvania, Philadelphia, PA
Figure. Fraction of free 90Y in the blood was significantly higher for patients treated with dilute contrast medium than in those treated with D5W (median, 0.5% of injected activity vs 0.2%; P 1⁄4 .001).
The authors prospectively evaluated 20 patients with hepatic metastases during their first Y90 radioembolization treatment. Y90 was dosed via the body surface area method. Microspheres were delivered either by flushing with D5W and intermittent contrast injection per the manufacturer instructions or by flushing with dilute 50% Isovue 300 in saline. Blood was drawn prior to the treatment, immediately after Y90 delivery, and at 10, 20, 60, and 120 minutes after Y90 delivery. Patients were observed for 1 month to evaluate for adverse events. Blood samples were analyzed using a gamma counter to measure counts per minute. The percent of radioactivity elution in the blood was calculated.
10 participants received Y90 with D5W and 10 participants received Y90 with diluted 50% Isovue 300. The percentage of free Y90 in the blood was significantly greater in subjects who received Y90 with Isovue 300 compared to D5W. Y90 flushed with dilute 50% Isovue was associated with shorter fluoroscopy times and lower air kerma compared to delivery with D5W . Technical success rate was 100%. One D5W treatment and two Isovue treatments were terminated early for stasis. There were zero immediate procedural complications. 12 participants experienced an adverse event at one month, eight of which were postembolization syndrome.
Maxwell Cretcher, D.O.
Integrated Interventional Radiology Resident, PGY-4
Department of Interventional Radiology
Dotter Interventional Institute, Oregon Health and Science University