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Repeat Evaluation of Lung Shunt Fraction is Unnecessary: A Retrospective Observational Study of Successive Lung Shunt Fractions from Variable Arterial Distributions in Patients Undergoing Radioembolization of Primary and Secondary Liver Tumors.
- Source :
-
Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2021 Mar; Vol. 32 (3), pp. 412-418. Date of Electronic Publication: 2020 Dec 17. - Publication Year :
- 2021
-
Abstract
- Purpose: To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization.<br />Materials and Methods: Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms and LSF calculations. A total of 160 LSF calculations were made using planar imaging (155, [97%]) and single-photon emission computed tomography (5 [3%]) technetium-99m macroaggregated albumin hepatic arterial injection imaging. The mean patient age was 61.8 years ± 12.7; 69 (86%) patients had metastatic disease and 11 (14%) had hepatocellular carcinoma.<br />Results: Patients had a median LSF of 5% (interquartile range [IQR] 3%-9%) with a median absolute difference of 1.25 (IQR 0.65-3.4) and a median of 76 days (IQR 42.5-120 days) between repeat LSF calculations. There was a median change in LSF of 0.2% between mapping studies (P = .11). There was no statistical significance between the repeat LSFs regardless of the arterial distribution (P = .79) or between tumor types (P = .75). No patients exceeded lung dose limits using actual or predicted prescribed dose amounts. The actual median lung dose was 2.6 Gy (IQR 1.8-4.4 Gy, maximum = 20.5) for the first radioembolization and 2.0 Gy (IQR 1.3-3.7 Gy, maximum = 10.1) for the second radioembolization.<br />Conclusions: No significant difference in LSF was identified between different time points and arterial distributions within the same patient undergoing repeat radioembolization. In patients who receive well under 30-Gy lung dose for the initial treatment and a 50-Gy cumulative lung dose, repeat radioembolization treatments in the same patient may not require a repeat LSF calculation.<br /> (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular pathology
Female
Humans
Liver Circulation
Liver Neoplasms pathology
Liver Neoplasms secondary
Male
Middle Aged
Predictive Value of Tests
Pulmonary Circulation
Radiation Dosage
Radiation Pneumonitis diagnostic imaging
Radiation Pneumonitis etiology
Radiopharmaceuticals adverse effects
Retreatment
Retrospective Studies
Risk Assessment
Risk Factors
Technetium Tc 99m Aggregated Albumin administration & dosage
Treatment Outcome
Angiography
Carcinoma, Hepatocellular therapy
Embolization, Therapeutic adverse effects
Liver Neoplasms therapy
Lung diagnostic imaging
Radiation Pneumonitis prevention & control
Radiopharmaceuticals administration & dosage
Single Photon Emission Computed Tomography Computed Tomography
Subjects
Details
- Language :
- English
- ISSN :
- 1535-7732
- Volume :
- 32
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of vascular and interventional radiology : JVIR
- Publication Type :
- Academic Journal
- Accession number :
- 33341340
- Full Text :
- https://doi.org/10.1016/j.jvir.2020.11.005