Prerequisites for treatment of hepatic malignancy with Yttrium-90 microspheres

2401 Objectives Selective internal radiation therapy (SIRT) with Yttrium-90 microspheres is a powerful emerging tool for achieving regional tumor response and disease control in hepatic malignancy. Some tumors, which have been unresponsive to other treatment modalities, respond to this potent therapeutic modality due to achievement of high doses of radiation locally which is not possible by external beam radiation. This study aims to identify various considerations for treatment with Yttrium-90 microspheres with specific emphasis on evaluating anatomical barriers to SIRT. Methods After IRB review and approval, a retrospective review was conducted of medical records and relevant images of patients who underwent hepatic arteriogram with selective visceral catheterization and therapy simulation with Tc 99m macro-aggregated albumin (Tc-99m MAA) from January 1st, 2009 to July 31st, 2010 at The Nebraska Medical Center. This approximates a total of 17 patients. This review involved Tc-99m MAA scintigrams, contrast CT scans, MRIs and pertinent medical history of these patients. We then evaluated various reasons for exclusion of the five patients who were not treated with Y-90 microspheres. Results Five of 17 patients did not receive treatment with Y-90 microspheres therapy following scintigraphy with Tc-99m MAA and hepatic arteriography. Only one patient had lung shunt fraction > 10% (LSF was 12%) which required the treatment dose to be decreased to 80% of the calculated full dose of Y-90 microspheres. Conclusions Careful patient selection, meticulous pre-treatment assessment and coiling of the relevant abnormal vasculature makes it possible for the interventional radiologist to treat liver lesions with Y-90 microspheres in spite of abnormal vasculature. The interdisciplinary aspect of patient management for treatment with Y-90 microspheres is crucial