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Catheter-Directed Computed Tomography Hepatic Angiography for Yttrium-90 Selective Internal Radiotherapy of Hepatocellular Carcinoma Reduces Prophylactic Embolization of Extrahepatic Vessels

  • Clinical Investigation
  • Imaging
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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.

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Acknowledgements

WXT Goh would like to thank the AM-ETHOS Duke-NUS Medical Student Fellowship Award and the SingHealth Medical Student Talent Development Award for giving him the opportunity to work with faculty from the SingHealth Duke-NUS Radiological Sciences Academic Clinical Programme. The authors also thank Miss Hlaing Hlaing Win (clinical research coordinator) and Mr Cornelio Gutierrez Padre (principal radiographer) from Department of Vascular and Interventional Radiology SGH for their contributions to this publication.

Funding

This study was not supported by any funding.

Author information

Author notes

  1. Winfred Xi Tai Goh, Sum Leong and Chow Wei Too have contributed equally to this work.

Authors and Affiliations

  1. MOH Holdings Pte Ltd, Singapore, Singapore

    Winfred Xi Tai Goh, Rebekah Zhuyi Lee & Sean Tze Shen Ng

  2. Office of Academic and Clinical Development, Duke-NUS Medical School, Singapore, Singapore

    Sum Leong, Chow Wei Too, Lionel Tim-Ee Cheng, Richard Hoau Gong Lo, Kiang Hiong Tay, Shaun Xavier Ju Min Chan, Apoorva Gogna, Farah Gillan Irani, Nanda Venkatanarasimha, Kelvin Siu Hoong Loke, David Chee Eng Ng, Ankur Patel, Karthikeyan Damodharan, Luke Han Wei Toh & Bien Soo Tan

  3. Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore

    Sum Leong, Chow Wei Too, Richard Hoau Gong Lo, Kiang Hiong Tay, Shaun Xavier Ju Min Chan, Apoorva Gogna, Farah Gillan Irani, Nanda Venkatanarasimha, Ankur Patel, Karthikeyan Damodharan, Luke Han Wei Toh & Bien Soo Tan

  4. Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore

    Lionel Tim-Ee Cheng

  5. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore

    Seyed Ehsan Saffari

  6. Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore

    Kelvin Siu Hoong Loke & David Chee Eng Ng

  7. Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Pierce Kah Hoe Chow

  8. Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore

    Pierce Kah Hoe Chow

  9. Office of Clinical Sciences, Academic and Faculty Affairs, Duke-NUS Medical School, Singapore, Singapore

    Pierce Kah Hoe Chow

  10. Haaglanden Medical Centre, The Hague, The Netherlands

    Thijs August Johan Urlings

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  1. Winfred Xi Tai Goh
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  2. Sum Leong
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  3. Chow Wei Too
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Corresponding author

Correspondence to Sum Leong.

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Conflict of interest

We would like to declare the following financial disclosures: CW Too—research and travel grants from Sirtex Medical, RHG Lo—proctor for Sirtex Medical, A Gogna—proctor for Sirtex Medical, grant support from Boston Scientific, FG Irani—proctor for Sirtex Medical, N Venkatanarasimha—travel grants from Sirtex Medical, PKH Chow—research grants and honorarium from Sirtex Medical, DCE Ng—research grants from Sirtex Medical, Merck, and Bayer, BS Tan—research grants from Boston Scientific.

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Goh, W.X.T., Leong, S., Too, C.W. et al. Catheter-Directed Computed Tomography Hepatic Angiography for Yttrium-90 Selective Internal Radiotherapy of Hepatocellular Carcinoma Reduces Prophylactic Embolization of Extrahepatic Vessels. Cardiovasc Intervent Radiol 43, 478–487 (2020). https://doi.org/10.1007/s00270-019-02362-y

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