Recognizing and Managing Adverse Events in Y-90 Radioembolization

2021 ◽  
Vol 38 (04) ◽  
pp. 453-459
Author(s):  
Grace L. Laidlaw ◽  
Guy E. Johnson
Keyword(s):  
Adverse Events ◽  
Patient Care ◽  
Liver Tumors ◽  
Hepatic Metastases ◽  
Systemic Effects ◽  
Primary Liver Tumors ◽  
Transarterial Radioembolization ◽  
Prevention And Treatment ◽  
Yttrium 90

AbstractTransarterial radioembolization using yttrium-90 (Y-90) microspheres is an important therapy in the management of unresectable primary liver tumors or hepatic metastases. While radioembolization is generally well-tolerated, it is not free from adverse events, and familiarity with the prevention and treatment of radioembolization-specific complications is an important component of patient care. This article aims to review radioembolization-specific toxicities stratified by hepatic, extrahepatic, and systemic effects, with a focus on preventing and mitigating radioembolization-induced morbidity.

scholarly journals Labeling of Hinokitiol with 90Y for Potential Radionuclide Therapy of Hepatocellular Carcinoma

Processes ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 940
Author(s):  
Christelle Bouvry ◽  
Valérie Ardisson ◽  
Nicolas Noiret ◽  
Etienne Garin ◽  
Nicolas Lepareur
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radionuclide Therapy ◽  
Liver Tumors ◽  
Potential Treatment ◽  
Primary Liver Tumors ◽  
Transarterial Radioembolization ◽  
The World ◽  
Yttrium 90

Hepatocellular carcinoma (HCC), the most common form of primary liver tumors, is the fifth cancer in the world in terms of incidence, and third in terms of mortality. Despite significant advances in the treatment of HCC, its prognosis remains bleak. Transarterial radioembolization with radiolabeled microspheres and Lipiodol has demonstrated significant effectiveness. Here we present a new, simple radiolabeling of Lipiodol with Yttrium-90, for the potential treatment of HCC.

scholarly journals Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carcinoma

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Calvin Young ◽  
Anusree Subramonian ◽  
Charlene Argáez
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Transarterial Chemoembolization ◽  
Systemic Treatment ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Advanced Stage ◽  
Transarterial Radioembolization ◽  
90Y Microspheres ◽  
Yttrium 90

Transarterial radioembolization using yttrium-90 (90Y) microspheres is a therapeutic option for patients with intermediate- or advanced-stage hepatocellular carcinoma, including those with recurrent or inoperable hepatocellular carcinoma. Overall, the evidence suggests that patients treated with 90Y-based transarterial radioembolization may experience no difference in overall survival, progression-free survival, and tumour response when compared to patients who received transarterial chemoembolization therapies or systemic treatment with sorafenib or lenvatinib. Patients treated with transarterial radioembolization generally experienced similar rates of adverse events compared to those treated with transarterial chemoembolization, although there were some instances where treatment with transarterial radioembolization led to increased or decreased risks of specific adverse events. The comparative safety of transarterial radioembolization versus systemic treatment with sorafenib was unclear as the included studies did not statistically compare the risks of experiencing adverse events. Evidence regarding the cost-effectiveness of 90Y microspheres for treating hepatocellular carcinoma is conflicting. Three economic evaluations suggest treatment with transarterial radioembolization is likely to be cost-effective or dominant — less costly and more effective — compared to transarterial chemoembolization or systemic therapies, while a single economic study suggested treatment with sorafenib or lenvatinib is most likely to be cost-effective or dominant compared to transarterial radioembolization.

scholarly journals Effect of Yttrium-90 transarterial radioembolization in patients with non-surgical hepatocellular carcinoma: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247958
Author(s):  
Simon Lemieux ◽  
Alex Buies ◽  
Alexis F. Turgeon ◽  
Julie Hallet ◽  
Gaétan Daigle ◽  
...  
Keyword(s):  
Adverse Events ◽  
Progression Free Survival ◽  
Time To Progression ◽  
Free Survival ◽  
Transarterial Radioembolization ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Grade 3 ◽  
Intestinal Ulcers ◽  
Yttrium 90

Background Recently, the use of Yttrium-90 transarterial radioembolization in non-surgical hepatocellular carcinoma was suggested but the evidence supporting its use is unclear. Methods We searched Medline, Embase, Web of Science and Cochrane CENTRAL from inception up to April 14, 2020 for randomized controlled trials comparing Y90-TARE to standard of care in non-surgical HCC patients. Our primary outcome was overall survival (OS). Our secondary outcomes were progression-free survival, time to progression, disease control rate, grade ≥3 adverse events and rates of gastro-intestinal ulcers. Hazard ratios (HR) and risk ratios (RR) with random-effects model were used for our analyses. The risk of bias of the included studies was assessed using Cochrane’s RoB 2 tool. Results Of 1,604 citations identified, eight studies (1,439 patients) were included in our analysis. No improvement in overall survival were noted when Yttrium-90 transarterial radioembolization was compared to standard treatments (HR 0.99 [95% CI 0.81–1.21], 6 studies, I2 = 77.6%). However, Yttrium-90 transarterial radioembolization was associated with fewer grade ≥3 adverse events (RR 0.64 [95% CI 0.45–0.92], 7 studies, I2 = 66%). No difference was observed on other secondary outcomes. Discussion In non-surgical HCC patients, Yttrium-90 transarterial radioembolization was not associated with significant effect on survival, progression-free survival, time to progression, disease control rate and the incidence of gastro-intestinal ulcers but was however associated with significantly lower rates of grade ≥3 adverse events. Further randomized controlled trials are warranted to better delineate optimal treatment.

scholarly journals Yttrium-90 Radioembolization of Metastatic Adrenocortical Carcinoma to the Liver following Systemic Chemotherapy and Surgical Resection of the Primary Lesion

2020 ◽  
Vol 13 (1) ◽  
pp. 158-163
Author(s):  
Nicholas Pigg ◽  
Daniel Aboubechara ◽  
Roberto Fourzali ◽  
Brian Baigorri
Keyword(s):  
Case Report ◽  
Metastatic Disease ◽  
Adrenocortical Carcinoma ◽  
Liver Tumors ◽  
Primary Liver Tumors ◽  
Off Label ◽  
Metastatic Lesions ◽  
Potential Efficacy ◽  
The Right ◽  
Yttrium 90

Use of yttrium-90 (Y-90) is used for primary liver tumors and a handful of liver metastatic lesions. Y-90 treatment for metastatic adrenocortical carcinoma (ACC) to the liver is currently off-label, with one previously documented case report. In this case report, we present a 52-year-old woman with ACC and extensive liver metastatic disease. After failed chemotherapy, multidisciplinary discussion suggested potential Y-90 treatment for palliative purposes. After undergoing Y-90 treatment separately to the right and then the left hepatic lobes, subsequent patient visits demonstrated significantly improved clinical function as well as complete radiographic resolution of liver metastatic disease mainly from ACC. This case report demonstrates the potential efficacy of Y-90 for off-label uses in liver metastatic disease. This case and similar cases may open the door to a wide variety of potential indications for Y-90 treatment.

Treatment of Primary Liver Tumors with Yttrium-90 Microspheres (TheraSphere®) in High Risk Patients: Analysis of Survival and Toxicities

2009 ◽  
Vol 8 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Kelli A. Reardon ◽  
Alyson F. McIntosh ◽  
A. Tanner Shilling ◽  
Klaus D. Hagspiel ◽  
Abdullah Al-Osaimi ◽  
...  
Keyword(s):  
High Risk ◽  
Liver Tumors ◽  
Primary Liver Tumors ◽  
High Risk Patients ◽  
Risk Patients ◽  
Yttrium 90

Transarterial Radioembolization: Patient Selection and Microsphere Characteristics

2021 ◽  
Author(s):  
Mark A. Westcott
Keyword(s):  
United States ◽  
Adverse Events ◽  
Patient Selection ◽  
The United States ◽  
Manufacturing Processes ◽  
Patient Evaluation ◽  
Transarterial Radioembolization ◽  
Fundamental Physical ◽  
Hepatic Malignancies ◽  
Yttrium 90

AbstractTransarterial radioembolization (TARE) using yttrium-90 (90Y)-labeled microspheres has become increasingly adopted as an important treatment option for primary and metastatic hepatic malignancies. Rigorous patient evaluation and selection prior to TARE is critical to optimize the benefits of this therapy and minimize adverse events. Equally important for ensuring a successful 90Y program is a broad knowledge of the fundamental physical characteristics, manufacturing processes, and supply and delivery parameters of the different commercially available microspheres and those currently under investigation for use in the United States.

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