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Safe and Successful Yttrium-90 Resin Microsphere Radioembolization in a Heavily Pretreated Patient with Chemorefractory Colorectal Liver Metastases after Biliary Stent Placement above the Papilla.

Sotirchos VS, Petre EN, Brown KT, Brody LA, D'Angelica MI, DeMatteo RP, Kemeny NE, Sofocleous CT - Case Reports Hepatol (2014)

Bottom Line: We report a case of safe and successful yttrium-90 resin microsphere radioembolization in a patient with a long history of multiple recurrent colon cancer hepatic metastases progressing after hepatic resections, hepatic arterial chemotherapy, and multiple regimens of systemic chemotherapy.One month prior to radioembolization, a biliary stent was placed above the level of the ampulla to relieve tumor-related biliary obstruction and normalize bilirubin levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.

ABSTRACT
We report a case of safe and successful yttrium-90 resin microsphere radioembolization in a patient with a long history of multiple recurrent colon cancer hepatic metastases progressing after hepatic resections, hepatic arterial chemotherapy, and multiple regimens of systemic chemotherapy. One month prior to radioembolization, a biliary stent was placed above the level of the ampulla to relieve tumor-related biliary obstruction and normalize bilirubin levels.

No MeSH data available.


Related in: MedlinePlus

(a) Tc-99 MAA scintigraphy after pre-SIRT mapping demonstrated 6% lung shunting, within acceptable values (<20%). (b) Post-SIRT Bremsstrahlung SPECT/CT showed heterogeneous tracer distribution throughout the remaining left lobe of the liver. No extrahepatic shunting was seen.
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fig2: (a) Tc-99 MAA scintigraphy after pre-SIRT mapping demonstrated 6% lung shunting, within acceptable values (<20%). (b) Post-SIRT Bremsstrahlung SPECT/CT showed heterogeneous tracer distribution throughout the remaining left lobe of the liver. No extrahepatic shunting was seen.

Mentions: With bilirubin levels continuing to drop, the patient was considered a candidate for SIRT and underwent standard evaluation with pre-SIRT arteriography and Tc-99 macroaggregate albumin (MAA) mapping. Angiographic evaluation revealed tumor arterial supply by the left hepatic artery and the right phrenic artery. The latter was embolized with microcoils to redistribute arterial flow to the tumors via the hepatic artery and thus optimize 90Y microsphere distribution. Tc-99 MAA hepatic scintigraphy demonstrated 6% lung shunting (Figure 2(a)), within acceptable values (<20%). One month after biliary stent placement and two weeks after the mapping session, serum bilirubin levels were marginally above the upper limit of normal (1.4 mg/dL). SIR-spheres (90Y-resin microspheres; Sirtex Medical, Sydney, Australia) were injected selectively in the left hepatic artery through a microcatheter, delivering the entire dose of 52.6 mCi (1.95 GBq). SPECT/CT Bremsstrahlung liver imaging confirmed successful delivery of the full dose within the liver (Figure 2(b)), without any extrahepatic activity. The patient tolerated the procedure well, without any significant acute or delayed side effects/toxicities. Total bilirubin levels during this period did not exceed the levels before SIRT.


Safe and Successful Yttrium-90 Resin Microsphere Radioembolization in a Heavily Pretreated Patient with Chemorefractory Colorectal Liver Metastases after Biliary Stent Placement above the Papilla.

Sotirchos VS, Petre EN, Brown KT, Brody LA, D'Angelica MI, DeMatteo RP, Kemeny NE, Sofocleous CT - Case Reports Hepatol (2014)

(a) Tc-99 MAA scintigraphy after pre-SIRT mapping demonstrated 6% lung shunting, within acceptable values (<20%). (b) Post-SIRT Bremsstrahlung SPECT/CT showed heterogeneous tracer distribution throughout the remaining left lobe of the liver. No extrahepatic shunting was seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4281443&req=5

fig2: (a) Tc-99 MAA scintigraphy after pre-SIRT mapping demonstrated 6% lung shunting, within acceptable values (<20%). (b) Post-SIRT Bremsstrahlung SPECT/CT showed heterogeneous tracer distribution throughout the remaining left lobe of the liver. No extrahepatic shunting was seen.
Mentions: With bilirubin levels continuing to drop, the patient was considered a candidate for SIRT and underwent standard evaluation with pre-SIRT arteriography and Tc-99 macroaggregate albumin (MAA) mapping. Angiographic evaluation revealed tumor arterial supply by the left hepatic artery and the right phrenic artery. The latter was embolized with microcoils to redistribute arterial flow to the tumors via the hepatic artery and thus optimize 90Y microsphere distribution. Tc-99 MAA hepatic scintigraphy demonstrated 6% lung shunting (Figure 2(a)), within acceptable values (<20%). One month after biliary stent placement and two weeks after the mapping session, serum bilirubin levels were marginally above the upper limit of normal (1.4 mg/dL). SIR-spheres (90Y-resin microspheres; Sirtex Medical, Sydney, Australia) were injected selectively in the left hepatic artery through a microcatheter, delivering the entire dose of 52.6 mCi (1.95 GBq). SPECT/CT Bremsstrahlung liver imaging confirmed successful delivery of the full dose within the liver (Figure 2(b)), without any extrahepatic activity. The patient tolerated the procedure well, without any significant acute or delayed side effects/toxicities. Total bilirubin levels during this period did not exceed the levels before SIRT.

Bottom Line: We report a case of safe and successful yttrium-90 resin microsphere radioembolization in a patient with a long history of multiple recurrent colon cancer hepatic metastases progressing after hepatic resections, hepatic arterial chemotherapy, and multiple regimens of systemic chemotherapy.One month prior to radioembolization, a biliary stent was placed above the level of the ampulla to relieve tumor-related biliary obstruction and normalize bilirubin levels.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.

ABSTRACT
We report a case of safe and successful yttrium-90 resin microsphere radioembolization in a patient with a long history of multiple recurrent colon cancer hepatic metastases progressing after hepatic resections, hepatic arterial chemotherapy, and multiple regimens of systemic chemotherapy. One month prior to radioembolization, a biliary stent was placed above the level of the ampulla to relieve tumor-related biliary obstruction and normalize bilirubin levels.

No MeSH data available.


Related in: MedlinePlus