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Hepatic Tumor Therapy
Alec Jost, MD; Trevor Downing, MD; Brian Kouri, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Transarterial Y-90 radioembolization (TARE): Delivery of locally therapeutic radiation via transcatheter arterial injection of Y-90 microparticles into regions of liver
            • Beta emission (mean: 2.28 MeV) provides treatment dose; tissue penetration ~ 2.5 mm; t1/2 = 64.2 hours
            • 2 radiopharmaceuticals: Y-90 resin microparticles (SirSpheres) and glass microparticles (TheraSpheres)
          • Concept

            • Liver malignancies derive ~ 90% of blood supply from hepatic arteries, normal parenchyma 70% from portal vein
            • Targeted delivery of Y-90 microparticles allows destruction of tumor cells while sparing normal liver

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Procedure Steps

                    POST PROCEDURE

                    • Expected Outcome

                      • Posttherapy Imaging

                        OUTCOMES

                        • Complications

                          Selected References

                          1. Egger ME et al: Transarterial chemoembolization vs radioembolization for neuroendocrine liver metastases: A multi-institutional analysis. J Am Coll Surg. 230(4):363-70, 2020
                          2. Seraj SM et al: Pretreatment volumetric parameters of FDG-PET predict the survival after Yttrium-90 radio-embolization in metastatic liver disease. Am J Nucl Med Mol Imaging. 9(5):248-54, 2019
                          3. Uliel L et al: From the angio suite to the γ-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization--a comprehensive pictorial review. J Nucl Med. 53(11):1736-47, 2012
                          4. Miller FH et al: Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol. 188(3):776-83, 2007
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Preprocedure

                              • Procedure

                                • Post Procedure

                                  TERMINOLOGY

                                  • Definitions

                                    • Transarterial Y-90 radioembolization (TARE): Delivery of locally therapeutic radiation via transcatheter arterial injection of Y-90 microparticles into regions of liver
                                    • Beta emission (mean: 2.28 MeV) provides treatment dose; tissue penetration ~ 2.5 mm; t1/2 = 64.2 hours
                                    • 2 radiopharmaceuticals: Y-90 resin microparticles (SirSpheres) and glass microparticles (TheraSpheres)
                                  • Concept

                                    • Liver malignancies derive ~ 90% of blood supply from hepatic arteries, normal parenchyma 70% from portal vein
                                    • Targeted delivery of Y-90 microparticles allows destruction of tumor cells while sparing normal liver

                                  PREPROCEDURE

                                  • Indications

                                    • Contraindications

                                      • Preprocedure Imaging

                                        • Getting Started

                                          PROCEDURE

                                          • Procedure Steps

                                            POST PROCEDURE

                                            • Expected Outcome

                                              • Posttherapy Imaging

                                                OUTCOMES

                                                • Complications

                                                  Selected References

                                                  1. Egger ME et al: Transarterial chemoembolization vs radioembolization for neuroendocrine liver metastases: A multi-institutional analysis. J Am Coll Surg. 230(4):363-70, 2020
                                                  2. Seraj SM et al: Pretreatment volumetric parameters of FDG-PET predict the survival after Yttrium-90 radio-embolization in metastatic liver disease. Am J Nucl Med Mol Imaging. 9(5):248-54, 2019
                                                  3. Uliel L et al: From the angio suite to the γ-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization--a comprehensive pictorial review. J Nucl Med. 53(11):1736-47, 2012
                                                  4. Miller FH et al: Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol. 188(3):776-83, 2007