Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion.

Abstract

To assess radiation-induced cholecystitis in cases of cystic artery origin nearby the treatment zone for transarterial radioembolization (TARE) treatment. Patients with primary or secondary malignant liver tumors treated with TARE, in whom cystic artery was located in the surrounding area of the treatment zone on 99m-technetium-MAA angiograms, were included in this study. Whole liver dose, tumor dose and healthy injected liver dose, lung dose and if applicable the gallbladder dose were all calculated by using the Medical Internal Radiation Dose (MIRD) formula from SPECT-CT images. Qualitative and quantitative assessment of the gallbladder was performed on SPECT-CT. The observed adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v5.0). A total of 34 TARE procedures from 29 patients (18 men and 11 women), with a mean age of 65 ± 13.3years meeting the inclusion criteria, were involved in the current study. The mean tumor dose, healthy injected liver dose, healthy whole liver dose and gallbladder dose were 204.9 ± 66.8Gy, 70.5 ± 15.7Gy, 31.1 ± 12.7Gy and 96.4 ± 53.4Gy, respectively. The mean follow-up period was 14 ± 5.2months. Qualitative assessment revealed gallbladder radioactivity on SPECT-CT in 11 (32.3%) patients with six mild and five moderate-severe radioactivities. There were no detected grade 2 or 3 adverse events. TARE is safely performed without cystic artery embolization when its origin is close to the treatment area.