Advanced

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds

Giammarile, Francesco; Bodei, Lisa; Chiesa, Carlo; Flux, Glenn; Forrer, Flavio; Kraeber-Bodere, Francoise; Brans, Boudewijn; Lambert, Bieke; Konijnenberg, Mark and Borson-Chazot, Francoise, et al. (2011) In European Journal of Nuclear Medicine and Molecular Imaging 38(7). p.1393-1406
Abstract
surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recentlyPrimary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of introduced tyrosine kinase inhibitors, e. g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et... (More)
surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recentlyPrimary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of introduced tyrosine kinase inhibitors, e. g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et al. (Cancer 56: 918-928, 1985); Schafer and Sorrell (Lancet 353: 1253-1257, 1999); Leong et al. (Arnold, London, 1999)]. Radioembolization is an innovative therapeutic approach defined as the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous intra-arterial techniques. Advantages of the use of these intra-arterial radioactive compounds are the ability to deliver high doses of radiation to small target volumes, the relatively low toxicity profile, the possibility to treat the whole liver including microscopic disease and the feasibility of combination with other therapy modalities. Disadvantages are mainly due to radioprotection constraints mainly for I-131-labelled agents, logistics and the possibility of inadvertent delivery or shunting [Novell et al. (Br J Surg 78: 901-906, 1991)]. The Therapy, Oncology and Dosimetry Committees have worked together in order to revise the European Association of Nuclear Medicine (EANM) guidelines on the use of the radiopharmaceutical I-131-Lipiodol (Lipiocis (R), IBA, Brussels, Belgium) and include the newer medical devices with Y-90-microspheres. Y-90 is either bound to resin (SIR-Spheres (R), Sirtex Medical, Lane Cove, Australia) or embedded in a glass matrix (TheraSphere (R), MDS Nordion, Kanata, ON, Canada). Since Y-90-microspheres are not metabolized, they are not registered as unsealed sources. However, the microspheres are delivered in aqueous solution: radioactive contamination is a concern and microspheres should be handled, like other radiopharmaceuticals, as open sources. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients undergoing such treatment. I-131-Lipiodol is a consolidated treatment option and the previous European Association of Nuclear Medicine (EANM) guidelines have been revised for its use. The newer Y-90-microsphere therapy is rapidly expanding throughout the nuclear medicine community. To date, published data on microspheres, particularly on dosimetry features and the characterization of the objective response, are still preliminary. Therefore, the aim of this part of the document is to set up a first basic procedure to guide nuclear medicine physicians in treatment with radiolabelled microspheres. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Guidelines, Nuclear medicine, Liver cancer, I-131-Ethiodized oil, I-131-Lipiodol, Lipiocis (R), Y-90-Microspheres, SIR-Spheres (R), TheraSphere (R), Resin-based spheres, Glass spheres, Radiomicrospheres
in
European Journal of Nuclear Medicine and Molecular Imaging
volume
38
issue
7
pages
1393 - 1406
publisher
Springer
external identifiers
  • wos:000292273400026
  • scopus:79958027914
ISSN
1619-7070
DOI
10.1007/s00259-011-1812-2
language
English
LU publication?
yes
id
95f4284a-a8dd-434d-9c10-9888e990836b (old id 2032303)
date added to LUP
2011-08-02 08:57:33
date last changed
2017-10-29 03:15:32
@article{95f4284a-a8dd-434d-9c10-9888e990836b,
  abstract     = {surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recentlyPrimary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of introduced tyrosine kinase inhibitors, e. g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et al. (Cancer 56: 918-928, 1985); Schafer and Sorrell (Lancet 353: 1253-1257, 1999); Leong et al. (Arnold, London, 1999)]. Radioembolization is an innovative therapeutic approach defined as the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous intra-arterial techniques. Advantages of the use of these intra-arterial radioactive compounds are the ability to deliver high doses of radiation to small target volumes, the relatively low toxicity profile, the possibility to treat the whole liver including microscopic disease and the feasibility of combination with other therapy modalities. Disadvantages are mainly due to radioprotection constraints mainly for I-131-labelled agents, logistics and the possibility of inadvertent delivery or shunting [Novell et al. (Br J Surg 78: 901-906, 1991)]. The Therapy, Oncology and Dosimetry Committees have worked together in order to revise the European Association of Nuclear Medicine (EANM) guidelines on the use of the radiopharmaceutical I-131-Lipiodol (Lipiocis (R), IBA, Brussels, Belgium) and include the newer medical devices with Y-90-microspheres. Y-90 is either bound to resin (SIR-Spheres (R), Sirtex Medical, Lane Cove, Australia) or embedded in a glass matrix (TheraSphere (R), MDS Nordion, Kanata, ON, Canada). Since Y-90-microspheres are not metabolized, they are not registered as unsealed sources. However, the microspheres are delivered in aqueous solution: radioactive contamination is a concern and microspheres should be handled, like other radiopharmaceuticals, as open sources. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients undergoing such treatment. I-131-Lipiodol is a consolidated treatment option and the previous European Association of Nuclear Medicine (EANM) guidelines have been revised for its use. The newer Y-90-microsphere therapy is rapidly expanding throughout the nuclear medicine community. To date, published data on microspheres, particularly on dosimetry features and the characterization of the objective response, are still preliminary. Therefore, the aim of this part of the document is to set up a first basic procedure to guide nuclear medicine physicians in treatment with radiolabelled microspheres.},
  author       = {Giammarile, Francesco and Bodei, Lisa and Chiesa, Carlo and Flux, Glenn and Forrer, Flavio and Kraeber-Bodere, Francoise and Brans, Boudewijn and Lambert, Bieke and Konijnenberg, Mark and Borson-Chazot, Francoise and Tennvall, Jan and Luster, Markus},
  issn         = {1619-7070},
  keyword      = {Guidelines,Nuclear medicine,Liver cancer,I-131-Ethiodized oil,I-131-Lipiodol,Lipiocis (R),Y-90-Microspheres,SIR-Spheres (R),TheraSphere (R),Resin-based spheres,Glass spheres,Radiomicrospheres},
  language     = {eng},
  number       = {7},
  pages        = {1393--1406},
  publisher    = {Springer},
  series       = {European Journal of Nuclear Medicine and Molecular Imaging},
  title        = {EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds},
  url          = {http://dx.doi.org/10.1007/s00259-011-1812-2},
  volume       = {38},
  year         = {2011},
}