First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation

We report a first experience involving the use of (90)Y radiolabelled microspheres (TheraSphere) for the treatment of mainly primary hepatic tumours. Treatment using TheraSphere microspheres was planned in 15 patients (13 with hepatocellular carcinoma, 2 with neuroendocrine tumour metastases). The treatment was preceded by a first angiography aimed at embolizing the vascularizing arterial branches of other structures outside the liver and evaluating the percentage of pulmonary shunt by scintiscanning after perfusion with (99m)Tc-MAA. The objective of the treatment carried out during a second angiography was to deliver a dose of 120 +/- 20 Gy (mean +/- SD) to the target hepatic volume. Technical difficulties were encountered in embolizing gastroduodenal or gastric branches in two patients and in one patient these led to cancellation of the treatment. A total of 14 patients were treated with an average activity of 3.18 GBq. In one patient, the injection was defective (stagnation of microspheres at the outlet of the catheter). SPECT/CT acquisitions provided important information in four patients (visualization of the gallbladder in three; visualization of the stomach in one, leading to a new coiling). The average exposure of the nuclear medicine physician carrying out the injections was 64 +/- 80 A mu Sv at the fingers. A partial response was seen in six patients, stabilization in five and progression in three. One patient presented with a gastric ulcer and two showed an increase in their hepatocellular insufficiency. Although sometimes technically difficult, the use of TheraSphere microspheres is a worthwhile therapeutic approach because of the low level exposure of operators and the encouraging rate of response or stabilization. The use of SPECT/CT contributes greatly to helping therapeutic planning, especially in the learning curve or when the angiographic procedure is difficult.