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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2021; 13(5): 440-452
Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.440
Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond
Mohammad Elsayed, Mohammad Loya, James Galt, David M Schuster, Zachary L Bercu, Janice Newsome, David Brandon, Sonia Benenati, Keywan Behbahani, Richard Duszak, Ila Sethi, Nima Kokabi
Mohammad Elsayed, Mohammad Loya, Zachary L Bercu, Janice Newsome, Sonia Benenati, Keywan Behbahani, Richard Duszak, Nima Kokabi, Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
James Galt, David M Schuster, David Brandon, Ila Sethi, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Elsayed M collected the data, performed the analysis, and wrote the paper; Loya M, Newsome J and Duszak R contributed to critical analysis and review of the manuscript; Galt J, Bercu ZL, Brandon D and Sethi I collected and contributed the data and analysis tools; Bercu ZL contributed to the data and the critical review of the manuscript; Benenati S collected and contributed the data; Behbahani K wrote the paper and provided critical review of the manuscript; Kokabi N conceived and designed the analysis and provided critical review of the manuscript.
Institutional review board statement: This series has been approved by the local Institutional Review Board, and the need for written informed consent was waived.
Conflict-of-interest statement: No authors received specific funding for the development of this manuscript. Kokabi N conducts Y-90 radioembolization research partially funded by Sirtex Medical Ltd; Duszak R receives research support from the Harvey L. Neiman Health Policy Institute.
Data sharing statement: No additional data is available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Keywan Behbahani, BSc, Academic Research, Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30322, United States. kbehbah@emory.edu
Received: December 8, 2020
Peer-review started: December 8, 2020
First decision: March 8, 2021
Revised: March 21, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 15, 2021
ARTICLE HIGHLIGHTS
Research background
Yttrium-90 (Y-90) radioembolization (RE) is an intra-arterial targeted liver therapy for patients with hepatic malignancies. Recent publications demonstrate that Y-90 RE can be performed as a single combined procedure, rather than a staged procedures performed over multiple days.
Research motivation
Given the coronavirus disease 2019 (COVID-19) pandemic, there has been an increased need to mitigate infection risk and logistical challenges. By reducing the number of in-person visits, same day Y-90 RE provides an opportunity to improve patient care for oncology patients during the COVID-19 and beyond. However, existing literature describing same day Y-90 RE predominantly report the use of planar scintigraphy without single photon emission computed tomography/computed tomography (SPECT/CT), which may limit the ability to optimize therapy for patients with more advanced malignancies. This retrospective analysis describes the use of pre- and post-treatment SPECT/CT with personalized dosimetry during the COVID-19 pandemic.
Research objectives
Describe the use of same day Y-90 RE with routine SPECT/CT.
Research methods
A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after Tc-99m MAA administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.
Research results
A total of 14 patients underwent same day Y-90 RE with SPECT/CT. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. All patients tolerated the procedure well and were discharged the same day.
Research conclusions
Same day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic. Consideration of routine SPECT/CT is recommended, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.
Research perspectives
Further studies of long-term patient outcomes and cost-benefit analyses would be useful to validate the utility of same day Y-90 with SPECT/CT.
