Division of Vascular and Interventional Radiology, Department of Radiology, University of California, 200 West Arbor Dr, San Diego, California, 92103, USA.
Cardiovasc Intervent Radiol. 2024 Sep;47(9):1239-1245. doi: 10.1007/s00270-024-03799-6. Epub 2024 Jul 8.
Transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) is performed after a mapping angiogram involving infusion of radiolabeled macroaggregated albumin to assess for non-target embolization and pulmonary shunting. The purpose of this case series was to evaluate the safety and feasibility of single-session TARE without the initial procedure.
A single-institution case series of 16 consecutive procedures on 15 patients with 18 tumors who underwent an attempted single-session TARE procedures with glass microspheres are presented. A lung shunt fraction (LSF) of 5% was assumed for planning purposes.
Sixty-seven percent (10/15) of patients were male with a median age of 72 years. Median tumor size was 2.5 cm (IQR 2.0-3.2 cm). Sixteen of the 18 targeted tumors were untreated prior to the single-session TARE. Rate of technical success was 88% (14/16). Two patients did not ultimately receive a single-session TARE due to intraprocedural findings. The mean administered activity was 2.0 GBq, and the mean MIRD dose was 464 Gy based on pre-treatment anatomic imaging and 800 Gy based on cone-beam CT. There were no cases of radiation pneumonitis. Mean post-procedural calculated lung dose was 4.9 Gy (range 3.1-9.3) based on SPECT.
An initial experience with single-session TARE using Y-90 glass microspheres without pre-procedural mapping angiography and lung shunt estimation demonstrates that it is a feasible and safe treatment option for select patients with small (< 5 cm) HCC.
Level 4 case series.
经动脉放射性栓塞术（TARE）用于治疗肝细胞癌（HCC），在进行放射性标记的大聚合白蛋白输注的映射血管造影术以评估非目标栓塞和肺分流后进行。本病例系列的目的是评估单次 TARE 治疗而不进行初始程序的安全性和可行性。
呈现了一个机构的 15 例患者 18 个肿瘤的连续 16 例手术的单中心病例系列，这些患者接受了玻璃微球的单次 TARE 尝试。假设肺分流分数（LSF）为 5%，用于计划目的。
67%（10/15）的患者为男性，中位年龄为 72 岁。中位肿瘤大小为 2.5cm（IQR 2.0-3.2cm）。在进行单次 TARE 之前，18 个靶向肿瘤中有 16 个未接受治疗。技术成功率为 88%（14/16）。由于术中发现，有 2 名患者最终未接受单次 TARE。平均给予的活度为 2.0GBq，基于治疗前解剖成像的平均 MIRD 剂量为 464Gy，基于锥形束 CT 的平均 MIRD 剂量为 800Gy。没有放射性肺炎的病例。基于 SPECT，术后平均计算的肺剂量为 4.9Gy（范围 3.1-9.3）。
使用 Y-90 玻璃微球进行初始单次 TARE 经验，无需进行术前映射血管造影术和肺分流估计，表明对于小（<5cm）HCC 的特定患者，这是一种可行且安全的治疗选择。
证据水平 IV：四级病例系列。
