Intrahepatic flow diversion prior to segmental Yttrium-90 radioembolization for challenging tumor vasculature

作     者：Lindsay B.Young Marcin Kolber Michael J.King Mona Ranade Vivian L.Bishay Rahul S.Patel Francis S.Nowakowski Aaron M.Fischman Robert A.Lookstein Edward Kim Lindsay B.Young;Marcin Kolber;Michael J.King;Mona Ranade;Vivian L.Bishay;Rahul S.Patel;Francis S.Nowakowski;Aaron M.Fischman;Robert A.Lookstein;Edward Kim

作者机构：Icahn School of Medicine at Mount Sinai Deparmnent of DignostcMolecular and lterventionl RadiologyOne Gustave L.Levry Place Box 1234NY100296574New YorkUSA University of Teras Southwestem Medical CenterDivision of Vascular and Inerentional Radiology5323 Hary Hines BhvdTx753909316DallasUSA David Geffen School of Medicine at the Univerity of Calfornia-LoS AngelesDeparment of Itrentionol Radiology27235 Toumey RoadSuite 1500Califormia91355ValenciaUSA 

出 版 物：《Journal of Interventional Medicine》 (介入医学杂志（英文）)

年 卷 期：2022年第5卷第2期

页      面：79-83页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：embolization routine balloon 

摘      要：Background: Hepatic tumors with complex vascular supply or poor relative perfusion are prone to decreased rates of objective response. This is compounded in the setting of Yttrium-90(Y90) transarterial radioembolization(TARE), which is minimally embolic and flow-dependent, relying on high threshold dose for complete ***: We describe our experience with intrahepatic flow diversion(FD) prior to TARE of hepatocellular carcinoma(HCC) with challenging vascular *** and methods: Between April 2014 and January 2020, 886 cases of coinciding MAA or TARE and bland embolization or temporary occlusion were *** embolizations performed for more routine purposes were excluded. FD was performed by bland embolization or temporary occlusion of vessels supplying non-malignant parenchyma in cases where flow was not preferential to target tumor. Lesion characteristics, vascular supply, treatment approach, angiography, and adverse events(AEs) were reviewed. Radiographic response was assessed using mRECIST ***: 22 cases of FD of focal HCC were identified. Embolics included calibrated microspheres(n = 11), microcoils(n = 4), gelfoam(n = 3), temporary balloon occlusion(n = 2) and temporary deployment of a microvascular plug(n = 1). Post-treatment SPECT-CT dosimetry coverage was concordant with target lesions in all cases. Mean follow-up was 16.7 months(1.4–45 mos). Tumor-specific response per m RECIST was 41% complete response, 50% objective response, and 59% disease control rate. No major adverse events or grade 3/4 hepatotoxicity were ***: Our findings suggest that FD prior to TARE is safe and potentially effective in treating HCC with complex vascular supply or poor tumor perfusion.