Abstract
To determine the feasibility and safety of performing same day diagnostic angiography with in-room planar nuclear medicine imaging and immediate dose calculation followed by Y90 treatment A single-institution prospective IRB-approved clinical trial was performed from June 2017 to June 2018. All adult patients scheduled for Y90 resin RE for primary or metastatic tumors with less than 50% liver tumor burden were eligible for this study. All patients underwent diagnostic angiography with in-room cone-beam CT or CT angiography to confirm treatment plan volumes and assess extrahepatic perfusion at the time of 99mTc-MAA (MAA) injection. MAA was administered and in-room planar imaging with portable gamma camera (Ergo, Digirad, Poway, CA) was performed for lung shunt calculation. Dosimetry was then calculated using BSA or partition method (PM) using preprocedure cross-sectional imaging and the Y90 activity was prepared in hospital radiopharmacy. Prior to Y90 administration, all lung doses were confirmed to be less than 30 Gy per package insert. Post procedure follow up was recorded at 1, 3, 6 months. The study included 12 patients. For process optimization, the first 2 patients had in-room imaging, dose calculation and preparation without treatment. The subsequent 10 patients all received the Y90 treatment in the same single session. Seven patients had metastatic disease and 3 had primary liver malignancy. Eight patients received lobar treatments and 2 patients had 2 segmental treatments each. Median delivered activity per patient was 29.5 mCi (10-81.6). In 9 cases PM was used for dosimetry for higher calculated activity. The median shunt fraction was 2% (0.4-7.5). Median time from MAA injection to shunt calculation was 26 (18-32) minutes. Median total in-room time 143 (118-269) minutes and median procedure times were and 110 (75-225) minutes. No grade 3 or higher toxicities or GI ulcers occurred. The preprocedural plan for treatment was successfully completed in all patients without modification. In carefully selected patients, in-room diagnostic angiography, planar shunt fraction imaging and activity preparation with immediate Y90 administration is safe and feasible.
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