Recommendations for radioembolisation after liver surgery using yttrium-90 resin microspheres based on a survey of an international expert panel
Samim M (1,2), van Veenendaal LM (3), Braat MNGJA (3), van den Hoven AF (3), Van Hillegersberg R (4), Sangro B (5), Kao YH (6), Liu D (7), Louie JD (8), Sze DY (8), Rose SC (9), Brown DB (10), Ahmadzadehfar H (11), Kim E (12), van den Bosch MAAJ (3), Lam MGEH (3).
(1) Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. M.firstname.lastname@example.org.
(2) Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. M.email@example.com.
(3) Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
(4) Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
(5) Liver Unit, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Pamplona, Spain.
(6) Department of Nuclear Medicine, Cabrini Hospital, Melbourne, Australia.
(7) Department of Radiology, Vancouver General Hospital. University of British Columbia, Vancouver, British Columbia, Canada.
(8) Division of Interventional Radiology, Stanford University Medical Center, Stanford, USA.
(9) Department of Radiology, University of California, San Diego, USA.
(10) Department of Radiology, Vanderbilt University, Medical Center North, Nashville, USA.
(11) Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany.
(12) Division of Vascular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
Guidelines on how to adjust activity in patients with a history of liver surgery who are undergoing yttrium-90 radioembolisation (90Y-RE) are lacking. The aim was to study the variability in activity prescription in these patients, between centres with extensive experience using resin microspheres 90Y-RE, and to draw recommendations on activity prescription based on an expert consensus.
The variability in activity prescription between centres was investigated by a survey of international experts in the field of 90Y-RE. Six representative post-surgical patients (i.e. comparable activity prescription, different outcome) were selected. Information on patients' disease characteristics and data needed for activity calculation was presented to the expert panel. Reported was the used method for activity prescription and whether, how and why activity reduction was found indicated.
Ten experts took part in the survey. Recommendations on activity reduction were highly variable between the expert panel. The median intra-patient range was 44 Gy (range 18-55 Gy). Reductions in prescribed activity were recommended in 68% of the cases. In consensus, a maximum DTarget of 50 Gy was recommended.
With a current lack of guidelines, large variability in activity prescription in post-surgical patients undergoing 90Y-RE exists. In consensus, DTarget ≤50 Gy is recommended.
• BSA method does not account for a decreased remnant liver volume after surgery. • In post-surgical patients, a volume-based activity determination method is recommended. • In post-surgical patients, a mean D Target of ≤ 50Gy should be aimed for.
CITATION Eur Radiol. 2017 Jul 3. doi: 10.1007/s00330-017-4889-6