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Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Gastroenterology & Hepatology
  • Yttrium-90 radioembolization
  • Same day
  • Selective internal radiotherapy
  • Transarterial radioembolization
  • Single photon emission computed tomography/computed tomography
  • Dosimetry
  • COVID-19
  • HEPATOCELLULAR-CARCINOMA PATIENTS
  • PERSONALIZED DOSIMETRY
  • RESIN MICROSPHERES
  • RADIATION-THERAPY
  • TUMOR RESPONSE
  • SURVIVAL
  • SPECT/CT
  • SIRT
  • IMPACT
  • SAFETY

Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

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Journal Title:

WORLD JOURNAL OF GASTROINTESTINAL ONCOLOGY

Volume:

Volume 13, Number 5

Publisher:

, Pages 440-452

Type of Work:

Article

Abstract:

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access. AIM: To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy. METHODS: All patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles. RESULTS: A total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day. CONCLUSION: Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
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